{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T19:28:39Z","timestamp":1787167719971,"version":"build-2736575974"},"reference-count":44,"publisher":"American Medical Association (AMA)","issue":"7","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Surg"],"published-print":{"date-parts":[[2023,7,1]]},"abstract":"\n Importance<\/jats:title>\n Immediate consequences of trauma include a rapid and immense activation of the immune system, whereas long-term outcomes include premature death, physical disability, and reduced workability.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To investigate if moderate to severe trauma is associated with long-term increased risk of death or immune-mediated or cancer disease.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This registry-based, matched, co-twin control cohort study linked the Danish Twin Registry and the Danish National Patient Registry to identify twin pairs in which 1 twin had been exposed to severe trauma and the other twin had not from 1994 to 2018. The co-twin control design allowed for matching on genetic and environmental factors shared within twin pairs.<\/jats:p>\n <\/jats:sec>\n \n Exposure<\/jats:title>\n Twin pairs were included if 1 twin had been exposed to moderate to severe trauma and the other twin had not (ie, co-twin). Only twin pairs where both twins were alive 6 months after the trauma event were included.<\/jats:p>\n <\/jats:sec>\n \n Main Outcome and Measure<\/jats:title>\n Twin pairs were followed up from 6 months after trauma until 1 twin experienced the primary composite outcome of death or 1 of 24 predefined immune-mediated or cancer diseases or end of follow-up. Cox proportional hazards regression was used for intrapair analyses of the association between trauma and the primary outcome.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n A total of 3776 twin pairs were included, and 2290 (61%) were disease free prior to outcome analysis and were eligible for the analysis of the primary outcome. The median (IQR) age was 36.4 (25.7-50.2) years. The median (IQR) follow-up time was 8.6 (3.8-14.5) years. Overall, 1268 twin pairs (55%) reached the primary outcome; the twin exposed to trauma was first to experience the outcome in 724 pairs (32%), whereas the co-twin was first in 544 pairs (24%). The hazard ratio for reaching the composite outcome was 1.33 (95% CI, 1.19-1.49) for twins exposed to trauma. Analyses of death or immune-mediated or cancer disease as separate outcomes provided hazard ratios of 1.91 (95% CI, 1.68-2.18) and 1.28 (95% CI, 1.14-1.44), respectively.<\/jats:p>\n <\/jats:sec>\n \n Conclusion and Relevance<\/jats:title>\n In this study, twins exposed to moderate to severe trauma had significantly increased risk of death or immune-mediated or cancer disease several years after trauma compared with their co-twins.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamasurg.2023.1560","type":"journal-article","created":{"date-parts":[[2023,5,17]],"date-time":"2023-05-17T11:02:58Z","timestamp":1684321378000},"page":"738","source":"Crossref","is-referenced-by-count":7,"title":["Association of Trauma With Long-Term Risk of Death and Immune-Mediated or Cancer Disease in Same-Sex Twins"],"prefix":"10.1001","volume":"158","author":[{"given":"Trine O.","family":"Eskesen","sequence":"first","affiliation":[{"name":"Department of Anesthesia and Trauma Centre, Section 6011, Center of Head 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