Dataset Information

Too much? Mortality and health service utilisation among Danish children 1999-2016: A register-based study.

ABSTRACT:

Objectives

To describe the temporal development of mortality and health service utilisation defined as in- and outpatient hospital contacts, contacts with general practitioner and specialists, and prescribed dispensed medication among Danish children 0-5 years of age from 1999 to 2016.

Design

Participants

All children born in Denmark in the period 1994-2016 followed until 5 years of age.

Main outcome measures

Annual incidence rates of mortality and health service utilisation outcomes, and incidence rate ratios compared to the reference calendar year 1999. The new measure of post-discharge mortality is presented.

Results

Post-discharge mortality decreased from 1999 to 2016, IRR2016 = 0.49 (95% CI: 0.36 to 0.66). Total contacts did not change much over time, IRR2016 = 1.02 (1.02 to 1.03), but increased among neonates, IRR2016 = 3.69 (3.63 to 3.75), and decreased among children with chronic disease IRR2016 = 0.94 (0.93 to 0.94). In- and out-patient hospitalisations increased, IRR2016 = 1.26 (1.24-1.27) resp. IRR2016 = 1.62 (1.60-1.63), contacts with medical specialists increased, IRR2016 = 1.43 (1.42 to 1.43), whilst contacts with general practitioner decreased, IRR2016 = 0.91 (0.91 to 0.91). Medication use decreased, IRR2016 = 0.82 (0.82 to 0.82).

Conclusions

Our measure of post-discharge mortality was halved during the study period indicating improved health. Overall health service utilisation did not change much, but the type of utilisation changed, and the development over time differed between subgroups defined by age and chronic disease status. Our findings call for considerations about the benefit of increased specialisation and increased use of health services among 'healthy' children not suffering from chronic disease.

SUBMITTER: Jensen A

PROVIDER: S-EPMC6821095 | biostudies-literature | 2019

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Too much? Mortality and health service utilisation among Danish children 1999-2016: A register-based study.

Jensen Andreas A Andersen Per Kragh PK Andersen John Sahl JS Greisen Gorm G Stensballe Lone Graff LG

PloS one 20191030 10

<h4>Objectives</h4>To describe the temporal development of mortality and health service utilisation defined as in- and outpatient hospital contacts, contacts with general practitioner and specialists, and prescribed dispensed medication among Danish children 0-5 years of age from 1999 to 2016.<h4>Design</h4>Register-based descriptive study.<h4>Participants</h4>All children born in Denmark in the period 1994-2016 followed until 5 years of age.<h4>Main outcome measures</h4>Annual incidence rates o ...[more]

PMID: 31665167

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Project description:OBJECTIVES:Estimating associations between somatic and socioeconomic risk factors and post-discharge under-five mortality. DESIGN:Register-based national cohort study using multiple Cox regression. PARTICIPANTS:The population of 1,263,795 Danish children live-born 1997-2016 who survived until date of first discharge to the home after birth was followed from that date until death, emigration, 5 years of age or 31 December 2016. MAIN OUTCOME MEASURES:(A) Mortality hazard ratios (HRs) among all children, (B) mortality HRs among children without severe chronic disease, and (C) mortality HRs among children without severe chronic disease or asthma. MAIN RESULTS:In the total population (1,947 deaths) severe chronic disease was associated with mortality HR = 15.28 (95% CI: 13.77-16.95). In children without severe chronic-disease (719 deaths) other somatic risk factors were immature birth HR = 3.40 (1.92-6.02), maternal smoking HR = 1.84 (1.55-2.18) and low birth weight HR = 1.74 (1.21-2.51). Socioeconomic risk factors for mortality included: maternal age < 25 years HR = 1.91 (1.38-2.64) compared to > 35 years (similar for 30-35 years and 25-29 years), lowest vs. highest family income tertile HR = 1.76 (1.23-2.51), not living with both parents HR = 1.63 (1.25-2.13), maternal unemployment HR = 1.54 (1.12-2.12), presence of siblings HR = 1.44 (1.20-1.71) and secondary vs. tertiary parental education HR = 1.33 (1.07-1.65) for fathers and HR = 1.23 (1.01-1.52) for mothers. Factors not found to be associated with child mortality in this population included presence of asthma HR = 1.29 (0.83-1.98) and non-Danish ethnicity HR = 0.98 (0.70-1.37). CONCLUSIONS:Childhood death after discharge to the home after birth and before 5 years of age is a very rare event in Denmark. This 'post-discharge' mortality was heavily associated with severe chronic disease. In children without severe chronic disease, immature birth, maternal smoking and certain socioeconomic characteristics were noticeable risk factors. Mortality may possibly be decreased by focusing on vulnerable groups.

Project description:BackgroundThe existing literature indicates that unemployment leads to deteriorated mental and somatic health, poorer self-assessed health, and higher mortality. However, it is not clear whether and to what extent the health consequences of unemployment differ between men and women. According to social role theory, women can alternate between several roles (mother, wife, friend, etc.) that make it easier to deal with unemployment, whereas the worker role is more important for men, and unemployment could therefore be more harmful to them. Thus, gender differences in the health consequences of unemployment should decrease as society grows more gender equal. Accordingly, this study examines changes over time in the gendered health consequences of unemployment in Norway. METHODS: Linked Norwegian administrative register data, covering the period from 2000 to 2017, were analysed by means of linear probability models and logistic regression. Four health outcomes were investigated: hospitalisation, receiving sick pay, disability benefit utilisation, and the likelihood of mortality. Two statistical models were estimated: adjusted for (1) age, and (2) additional sociodemographic covariates. All analyses were run split by gender. Three different unemployment cohorts (2000, 2006, and 2011) that experienced similar economic conditions were followed longitudinally until 2017.ResultsThe empirical findings show, first, that hospital admission is somewhat more common among unemployed males than among unemployed females. Second, receiving sick pay is much more common post-unemployment for men than for women. Third, excess mortality is higher among unemployed males than among unemployed females. Fourth, there is no gender component in disability benefit utilisation. There is a remarkable pattern of similarity when comparing the results for the three different unemployment cohorts (2000; 2006; 2011). Thus, the gendered health consequences of unemployment have hardly changed since the turn of the century.ConclusionThis paper demonstrates that the health consequences of unemployment are serious, gendered, and enduring in Norway.

Dataset Information

Too much? Mortality and health service utilisation among Danish children 1999-2016: A register-based study.

Objectives

Design

Participants

Main outcome measures

Results

Conclusions

Publications

Too much? Mortality and health service utilisation among Danish children 1999-2016: A register-based study.

Similar Datasets

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