In a Danish study reported in JAMA Surgery, Eskesen et al found moderate to severe physical trauma in one of same-sex twins was associated with an increased risk of the composite endpoint of death or immune-mediated disease or cancer vs their co-twins over long-term follow-up.
Study Details
The study used linked Danish Twin Registry and Danish National Patient Registry data to identify twin pairs in which one twin had been exposed to trauma and the other twin had not from 1994 to 2018. Moderate to severe trauma was defined as an Injury Severity Score ≥ 9. Twin pairs were followed from 6 months after trauma until one experienced the primary composite outcome of death, 1 of 24 predefined immune-mediated diseases or cancer, or the end of follow-up.
Key Findings
Of a total of 3,776 twin pairs identified, 2,290 pairs (61%) were disease-free prior to the outcome analysis and were included in the analysis of the primary outcome. Median follow-up was 8.6 years (interquartile range = 3.8–14.5 years).
Overall, 1,268 twin pairs (55%) reached the primary composite outcome; the trauma-exposed twin was first to experience the outcome in 724 pairs (32%), and the co-twin was first in 544 pairs (24%). The hazard ratio (HR) for reaching the composite outcome for twins with trauma vs co-twins was 1.33 (95% confidence interval [CI] = 1.19–1.49).
In analyses of individual components of the composite endpoint, death in the entire population (n = 3,776 pairs) was reached first for 641 trauma-exposed twins (17%) and 335 control twins (9%; HR = 1.91, 95% CI = 1.68–2.18). Among all 2,290 pairs eligible for analysis, immune-mediated disease or cancer was experienced first for 625 trauma-exposed twins (27%) and 488 co-twins (21%; HR = 1.28, 95% CI = 1.14–1.44). In a separate analysis of cancer, the hazard ratio did not reach statistical significance (HR = 1.03, 95% CI = 0.86–1.24).
The investigators concluded: “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.”
Trine O. Eskesen, MD, PhD, of the Department of Anesthesia and Trauma Centre, Section 6011, Center of Head and Orthopedics, Rigshospitalet, is the corresponding author of the JAMA Surgery article.
Disclosure: The study was supported by the Research Fund of Rigshospitalet, University of Copenhagen. For full disclosures of the study authors, visit jamanetwork.com.
