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Aim: To describe long-term care (LTC) use in Finland and Sweden in 2020, by reporting residential entry and exit patterns including hospital admissions and mortality, compared with the 2018–2019 period and community-living individuals. Methods: From national registers in Finland and Sweden, all individuals 70+ were included. Using the Finnish and Swedish study populations in January 2018 as the standard population, we reported changes in sex- and age-standardized monthly rates of entry into and exit from LTC facilities, mortality and hospital admission among LTC residents and community-living individuals in 2020. Results: Around 850,000 Finns and 1.4 million Swedes 70+ were included. LTC use decreased in both countries from 2018 to 2020. In the first wave (March/April 2020), Finland experienced a decrease in LTC entry rates and an increase in LTC exit rates, both more marked than Sweden. This was largely due to short-term movements. Mortality rates peaked in April and December 2020 for LTC residents in Finland, while mortality peaked for both community-living individuals and LTC residents in Sweden. A decrease in hospital admissions from LTC facilities occurred in April 2020 and was less marked in Finland versus Sweden. Conclusions: During the first wave of the pandemic mortality was consistently higher in Sweden. We also found a larger decrease in LTC use and, among LTC residents, a smaller decrease in hospital admissions in Finland than in Sweden. This study calls for assessing the health consequences of the differences observed between these two Scandinavian countries as part of the lessons from the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

Background: A growing proportion of children born in Europe are born to immigrant parents. Knowledge about their health is essential for preventive and curative medicine and health services planning. Objective: To investigate differences in diagnoses given in secondary and tertiary healthcare between Norwegian-born children to immigrant and non-immigrant parents. Methods: Data from the Medical Birth Registry of Norway, the Norwegian Patient Registry and Statistics Norway were linked by the national personal identification number. The study population included children born in Norway aged 0–10 years between 2008 and 2018 (N =1,015,267). Diagnostic categories from three main domains of physical health, given in secondary or tertiary care; infections, non-infectious medical conditions and non-infectious neurological conditions were included from 2008 onwards. Hazards of diagnoses by immigrant background were assessed by Cox regressions adjusted for sex and birth year. Results: Children of immigrants generally had higher hazards than children with Norwegian background of some types of infections, obesity, nutrition-related disorders, skin diseases, blood disease and genital disease. Children of immigrants from Africa also had higher hazards of cerebral palsy, cerebrovascular diseases and epilepsy. Conversely, most groups of children of immigrants had lower hazards of acute lower respiratory tract infections, infections of the musculoskeletal system, infections of the central nervous system, diseases of the circulatory system, hearing impairment, immune system disorders, chronic lower respiratory disease and headache conditions. Conclusions: Children of immigrants did not present with overall worse health than children without immigrant background, but the distribution of health problems varied between groups. [ABSTRACT FROM AUTHOR]

Aims: This study aimed to examine the population-based Skåne Health-care Register (SHR) regarding feasibility for scientific research and also strengths and weaknesses. Methods: To analyse the feasibility of the SHR, we performed a bibliographic search for peer-reviewed articles based on SHR data from 2000 to 2018. To analyse strengths and weaknesses, we used original SHR data about coverage and validity. Results: We identified 58 articles based on SHR data, covering different study designs and disorders. Most studies focused on musculoskeletal disorders with a cohort design. The majority of all consultations recorded in the SHR have an assigned diagnosis. However, this differs between the levels of care and between types of consultation. For inpatient care, the proportion of consultations with an assigned diagnosis was close to 100% between 1998 and 2017. The proportion of consultations with an assigned diagnosis was lowest within primary care, although the proportion markedly increased in 2004 when the prerequisite for consultation reimbursement was linked to the requirement for an assigned diagnosis. Limitations are that the SHR does not cover health-care provided within nursing homes and equivalent facilities or treatments received by the population of Skåne outside the region. Conclusions: The SHR may be used as a reliable data source for analyses of clinical changes and improvements. Extended use of the SHR in a research context may highlight important shortcomings within the register and thus serve as a way of indirect quality control. To enhance the use of the SHR further, better harmonisation between registers, within and outside of the region and internationally, is of crucial importance. [ABSTRACT FROM AUTHOR]

Aims: Non-response to population surveys is a common problem in epidemiological and public health research. Systematic non-response threatens the validity of results. Researchers rarely evaluate the magnitude of systematic non-response because of limited access to population data. This study explores how well morbidity and mortality in postal survey respondents aged 65 years and older represented that of the target population. Methods: The 2010 Stockholm Public Health Survey and the Swedish Population Register were linked to the Cause of Death Register and the National Patient Register in Sweden. Differences were analysed between the response group and the corresponding population in mortality, hospital admission, days spent in hospital and number of diagnoses. Finally, data were weighted for non-response to see if this improved generalizability. Results: Non-response increased with age, and this increase was more pronounced among women than men. Respondents were marginally less often admitted to hospital, hospitalized fewer days and had slightly fewer diagnoses than the population, in particular after age 80. Significantly fewer women died in the response group than in the population as a whole. In terms of mortality among men and in terms of hospitalizations for most age groups, the respondents represented the population fairly well. Non-response weighting adjustment did not improve generalizability. Conclusions: Postal questionnaires are likely to capture morbidity (hospitalization) among women and men aged 65-80 years old and mortality among men, while morbidity after age 80 and mortality in women are likely to be underestimated. [ABSTRACT FROM PUBLISHER]

Background: Acute myocardial infarction (MI) is a leading cause for morbidity and mortality in Sweden. We aimed to compare patients with an acute MI included in the Register of information and knowledge about Swedish heart intensive care admissions (RIKS-HIA, now included in the register Swedeheart) and in the Swedish statistics of acute myocardial infarctions (S-AMI). Methods: Population based register study including RIKS-HIA, S-AMI, the National patient register and the Cause of death register. Odds ratios were determined by logistic regression analysis. Results: From 2001 to 2007, 114,311 cases in RIKS-HIA and 198,693 cases in S-AMI were included with a discharge diagnosis of an acute MI. Linkage was possible for 110,958 cases. These cases were younger, more often males, had fewer concomitant diseases and were more often treated with invasive coronary artery procedures than patients included in S-AMI only. There were substantial regional differences in proportions of patients reported to RIKS-HIA. Conclusions: Approximately half of all patients with an acute MI were included in RIKS-HIA. They represented a relatively more healthy population than patients included in S-AMI only. S-AMI covered almost all patients with an acute MI but had limited information about the patients. Used in combination, these two registers can give better prerequisites for improved quality of care of all patients with acute coronary syndromes. [ABSTRACT FROM PUBLISHER]

Aims: The Finnish Hospital Discharge Register (FHDR) is one of the oldest individual level hospital discharge registers and has been intensively used for research purposes. The aim of this study was to gather information concerning the quality of FHDR into one place in terms of a systematic review of validation studies that compare data to external information. Methods: Several reference databases were searched for validity articles published until January 2012. For each included study, focus of validation, register years examined, number of compared observations, external source(s) of data, summary of validation results, and conclusions concerning the validity of FHDR were extracted. Results: In total, 32 different studies comparing FHDR data to external information were identified. Most of the studies examined validity in the case of vascular disease, mental disorders or injuries. More than 95% of discharges could be identified from the register. Positive predictive value (PPV) for common diagnoses was between 75 and 99%. Conclusions: Completeness and accuracy in the register seem to vary from satisfactory to very good in the register as long as the recognised limitations are taking into account. Poor recording of subsidiary diagnoses and secondary operations and other rarely used items are the most obvious limitations in validity, but do not compromise the value of data in FHDR in being used in studies that are not feasible to conduct otherwise. [ABSTRACT FROM PUBLISHER]

Introduction: Statistics Denmark has a number of registers about labour market affiliation, which includes information on employees, establishments and the relation between employees and establishments. Content: The registers describe a person’s attachment to the labour market, information on the establishments and information on the relations between persons and establishments. The registers presented either include information at one specific point in time each year (end of November) or during the year. Validity and coverage: Both the validity and coverage of the registers are considered to be high. Conclusion: These registers provide valuable information on personal labour market affiliation and can be used to study determinants and consequences of labour market affiliation. [ABSTRACT FROM PUBLISHER]

Introduction: Congenital heart defects (CHD) constitute the largest group of congenital defects with a prevalence at birth of 5—11 per 1000 live births, and the population of adults with CHD is increasing. However, few population-based long-term outcome data exist. Content: The Danish Register of Congenital Heart Disease holds data on patients diagnosed with CHD since 1963 and patients below 25 years of age with other types of heart disease. Validity and coverage: Overall and defect specific validation is ongoing. Conclusion: Together with other Danish registers, the Danish Register of Congenital Heart Disease provides extensive research possibilities. [ABSTRACT FROM PUBLISHER]

Introduction: Cause-specific mortality statistics is a valuable source for the identification of risk factors for poor public health. Content: Since 1875, the National Board of Health has maintained the register covering all deaths among citizens dying in Denmark, and since 1970 has computerised individual records. Validity and coverage: Classification of cause(s) of deaths is done in accordance to WHO’s rules, since 1994 by ICD-10 codes. A change in coding practices and a low autopsy rate might influence the continuity and validity in cause-specific mortality. Conclusion: The longstanding national registration of causes of death is essential for much research. The quality of the register on causes of death relies mainly upon the correctness of the physicians’ notification and the coding in the National Board of Health. [ABSTRACT FROM PUBLISHER]

Introduction: The Danish Twin Registry (DTR) has for more than 50 years been based on surveys and clinical investigations and over the two last decades also on register linkage. Currently these two approaches are merged within Statistics Denmark. Research topics: Here we report on three major groups of register-based research in the DTR that used the uniqueness of twinning. First, we focus on the ‘‘long-term prognosis’’ of being a twin compared with being a singleton and show that Danish twins have health trajectories in adulthood similar to singletons, which is a result of interest for twins and their families as well as a test of the fetal origins hypothesis that states that fetal growth restriction has long-term health consequences. Secondly, we summarise some of the most important register-based ‘‘classical twin studies’’, e.g. heritability studies on lifespan and exceptional longevity. Finally, we illustrate how the co-twin control method in a register setting can be used to control for the effect of rearing environment and genetic factors in studies of the association between exposures and health. Conclusion: The spectrum of register-based twin studies is very wide and have changed in accordance with methodological and data resource developments. [ABSTRACT FROM PUBLISHER]

Introduction: Researchers in Denmark have unique possibilities of register-based research in relation to migration, ethnicity, and health. This review article outlines how these opportunities have been used, so far, by presenting a series of examples. Research topics: We selected six registers to highlight the process of how migrant study populations have been established and studied in relation to different registers: The Danish Cancer Registry, the Danish Central Psychiatric Research Register, the Danish National Patient Register, the Danish National Health Service Register, the Danish Injury Register, and the Danish Medical Birth Register. Conclusion: Our paper documents the unique opportunities to study migration, ethnicity, and health through Danish national registers. Our examples show that in Denmark ‘‘country of birth’’ is the most commonly used measure. It renders information on whether the person is an immigrant or not, and on ethnic background. Data on migration background (i.e. refugee status vs. family reunification, etc.) is more difficult to obtain and therefore less used. It has been debated if ethnicity should be registered upon using health services; however, some consider it discriminatory. Although, we do not register ethnicity in relation to use of health care in Denmark, our possibilities of linkage between population registers and registers on diseases and healthcare utilisation appear to render the same potentials. [ABSTRACT FROM PUBLISHER]

Introduction: To present the work previously and presently being carried out based on the nationwide Childcare Database. Research topics: The Childcare Database comprises individually linked Danish register-based data on childcare attendance, childcare facility characteristics, child and family characteristics, and infectious disease hospitalisations. The database includes about 1 million children aged 0—5 years and has, since the creation, been linked with separate disease registers on atopic disease, pneumococcal disease, and childhood cancers. The present paper is a review of epidemiological studies based on the Childcare Database. Studies of childhood infections confirmed that childcare attendance dramatically increases the risk, but emphasised that the increased risk is often transient and confined to subsets of children. Studies of childhood cancers showed that early childhood infections are likely to reduce the risk of childhood leukaemia and that this risk reduction applies to all children. Conclusion: The Childcare Database is a unique data source for studying the association between childcare attendance and health outcomes. Further linkage with Danish registers is possible on an individual level. The studies based on the Childcare Database confirm and extend previous findings of an increased risk of infection associated with childcare attendance, as well as point towards a possible protective role of early infections in childhood cancer. [ABSTRACT FROM PUBLISHER]

Introduction: Denmark has been pioneering international psychiatric register research for decades. In this article we review central publications, by Danish and international authors, based on data from the Danish Psychiatric Central Research Register and other related registers. Research topics: Our aim was to describe the history, development and achievements of psychiatric research, based on the Danish national registers. The studies considered in this review can be categorized as follows: i) health service research, mainly studies on prevalence and incidence, ii) studies on the outcome of mental disorders, iii) studies on the aetiology of mental disorders. Conclusion: Studies based on Danish registers have provided significant contributions to international psychiatric research. The major advantage of the registers is that they cover the entire population, which makes the conduction of nationwide population-based studies possible. Furthermore, all information in the registers is connected to each citizen’s unique personal identification number, which enables linkage between various registers and biobanks. Such linkage studies have provided important knowledge on the aetiology of mental disorders. Despite inherent limitations about internal and external validity, the Danish national registers have been extremely valuable to international psychiatric research and will continue to play an important role in years to come. [ABSTRACT FROM PUBLISHER]

Aim: The objectives were to show how utilisation of hospital care among hip fracture patients has changed in Stockholm during 1998-2007 and to explore changes in some demographic and clinical characteristics as well as surgical treatment of the patients. Methods: The Stockholm County Patient Care Register covers all public healthcare services in the region. All patients from 1998 to 2007 who had a hospital stay due to a hip fracture (ICD-10 codes S72.0, S72.1, S72.2) and had undergone hip surgery (NCSP codes NFB09-99 and NFJ39-99) were identified. Number of hospital stays, surgical procedures, deaths, and length of hospital stay were categorised according to age and sex, and presented as absolute and relative numbers year by year. Age- and sex-standardised annual incidence figures were calculated. Results: A total of 28,528 patients (72.2% women, 27.8% men) were hospitalised due to a hip fracture. The annual numbers decreased during the study period in all age groups except men 85 years and older. The age- and sex-standardised hip fracture incidence fell with 16%. Mortality was slightly reduced. The acute care hospital length of stay fell with 1.4 days to 7.0 days, and the whole hospital episode increased by 1.4 days to 17.3 days. Conclusions: Despite a continued increase in the numbers of elderly during 1998-2007, the number of patients and their utilisation of hospital services remained constant and showed a marked decrease in women over 65 years of age. Comparisons with national statistics indicate that the results can be generalised to Sweden. [ABSTRACT FROM AUTHOR]

Objective — To examine the gender differences in long term (> 14 days) sickness absence due to musculoskeletal health problems.Design — Analysis of data from the National Sickness Benefit Register, 1994.Setting — The economically active population in Norway, except civil servants ( n = 1,978,030).Subjects — All persons, 16—66 years old, with long term sickness absence episodes due to musculoskeletal health problems in 1994 (n= 141,839).Main outcome measures — Cumulative incidence, episode frequency, and episode duration of sickness absence.Results — Women had higher cumulative incidence of sickness absence than men—80.6 pr 1,000 vs. 64.1 pr 1,000, and longer mean duration of episodes—94 calendar days vs. 86 days counted from the first day of absence. Episode frequency did not differ between the genders. After adjustment for age and income the gender ratio (men/women) in cumulative incidence changed from 0.80 to 1.08, and in mean duration from 0.91 to 0.96.Conclusion — Long term sickness absence due to musculoskeletal health problems was strongly associated with gender, age, income, and diagnosis. Multivariate analysis indicated that the large gender differences in sickness absence might be overstated due to lack of adjustment for income and income-related factors. [ABSTRACT FROM PUBLISHER]

A longitudinal study of altogether 1462 women aged 38 to 60 years started in Gothenburg, Sweden in 1968–69. Based on information from the population study and from the Swedish Cancer Registry 35 women had a history of malignant disease when initially examined in 1968–69. During a 12-year follow-up period a total of 79 malignant tumours developed in 73 women. A comparison was made between the 1988 Cancer Registry listing and the observations made in the population study. All but one out of 103 cases (99%) were registered in the Cancer Registry and all but one (99%) in the population study. It may be concluded that the accuracy of the population study registration as well as that of the Cancer Registry at that time were very high. This enables us to draw relatively safe conclusions from our own material when testing for risk factors. [ABSTRACT FROM PUBLISHER]

Introduction: The Danish Injury Register was established in 1988 and is based on injury case records from four Danish hospitals (five hospitals until 2007). Content: In total, 1.76 million cases were recorded during 1990—2008. Data items include the place of the accident, mechanism of injury, involved products, type of sports, and description of the accident. Validity and coverage: The register covers approximately 15% of the Danish population and is roughly representative for the whole Denmark in terms of age, sex, and social groups. Conclusion: The Danish Injury Register is a valuable source of information on injuries in Denmark, in particular product-related injuries and sports injuries. Further, the possibility to link to other registers increases the use of the data. [ABSTRACT FROM PUBLISHER]

Introduction: The Danish Multiple Sclerosis (MS) Registry was established in 1956. Content: The register comprises data on all Danes who had MS in 1949 or who have been diagnosed since. Data on new cases and updated information on persons with an MS diagnosis already notified are continuously collected and classified according to standardized diagnostic criteria. Validity and coverage: The completeness and validity is high (91% and 94%, respectively). Conclusion: In January 2005 the register included data on 20,652 persons with a valid MS diagnosis, of whom 9,377 were alive. The register is the only existing nationwide MS register and covers a period of more than 50 years. [ABSTRACT FROM PUBLISHER]

A Nordic study group, NORDSYN, consisting of ophthalmologists from Denmark (Thomas Rosenberg), Finland (Sirkka-Liisa Rudanko), Iceland (Gudmundur Viggosson), Norway (Tor Flage, Egill Hansen, Ruth Riise) and Sweden (Kristina Tornqvist), has compiled data from registers in Denmark, Finland, Iceland and Norway of 2527 visually impaired children. The Swedish register was established later in 1990. Each record contains the following information: sex, year of birth, year of registration, classification of visual impairment, ocular diagnosis, systemic diagnosis, aetiology and evt. additional impairments. The ocular diagnoses were compiled into groups among which congenital malformations and neuro-ophthalmological diseases were the most dominating. A coding system for aetiology was developed. It was demonstrated, that prenatal factors, including genetic aetiologies, were involved in a large proportion (66%) of the cases. The sex distribution revealed a dominance of males compared to the general population at the same age.The age-specific national prevalences for registration of childhood blindness (WHO-definition: best corrected visual acuity in the best eye less than 3/60 or visual field less than 10 degrees around fixation for the ages 0–15 years) were (N/100 000): Denmark 41, Finland 15, Iceland 19 and Norway 15. The differences were primarily presumed to be due to varying efficiency in registration.A coding system for additional impairments was developed. The proportion of visually impaired children with an additional mobility, hearing or mental impairment was between one third and one half of the national materials thus indicating the need for interdisciplinary tracing of and care for the visually impaired child. [ABSTRACT FROM PUBLISHER]