Research Article: CNS infections in Greenland: A nationwide register-based cohort study

Date Published: February 3, 2017

Publisher: Public Library of Science

Author(s): Anne Christine Nordholm, Bolette Søborg, Mikael Andersson, Steen Hoffmann, Peter Skinhøj, Anders Koch, Robyn S Klein.


Indigenous Arctic people suffer from high rates of infectious diseases. However, the burden of central nervous system (CNS) infections is poorly documented. This study aimed to estimate incidence rates and mortality of CNS infections among Inuits and non-Inuits in Greenland and in Denmark.

We conducted a nationwide cohort study using the populations of Greenland and Denmark 1990–2012. Information on CNS infection hospitalizations and pathogens was retrieved from national registries and laboratories. Incidence rates were estimated as cases per 100,000 person-years. Incidence rate ratios were calculated using log-linear Poisson-regression. Mortality was estimated using Kaplan-Meier curves and Log Rank test.

The incidence rate of CNS infections was twice as high in Greenland (35.6 per 100,000 person years) as in Denmark (17.7 per 100,000 person years), but equally high among Inuits in Greenland and Denmark (38.2 and 35.4, respectively). Mortality from CNS infections was 2 fold higher among Inuits (10.5%) than among non-Inuits (4.8%) with a fivefold higher case fatality rate in Inuit toddlers.

Overall, Inuits living in Greenland and Denmark suffer from twice the rate of CNS infections compared with non-Inuits, and Inuit toddlers carried the highest risk of mortality. Further studies regarding risk factors such as genetic susceptibility, life style and socioeconomic factors are warranted.

Partial Text

Infections of the central nervous system (CNS) include infection of the meninges and the brain. CNS infections are often severe with a heavy disease burden especially among infants [1].

To our knowledge, this is the first study to describe incidence and mortality from the total spectrum of CNS infections in Greenland. We found that Inuits in both Greenland and Denmark had twice the rate of CNS infection compared with non-Inuits in Greenland and in Denmark, with Inuit children under 2 years of age carrying a particular high risk of morbidity and mortality from these infections.




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