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Background: Alzheimer's disease (AD) is a major determinant of healthcare costs and increase in the healthcare service use occur already before the AD diagnosis. However, little is known how the different diagnosis categories contribute to this increase in healthcare use. We investigated how the hospitalizations and specialized healthcare outpatient visits from different diagnosis categories, based on the International Classification of Diseases (ICD-10) chapters, contribute to increased specialized healthcare service use during ten-year period preceding AD diagnosis. Methods: A register-based nationwide cohort of 42,934 community-dwelling persons who received clinically verified AD diagnosis in between 2008 and 2011 in Finland and 1:1 age, sex and hospital district- matched comparison cohort were included. Hospitalizations and specialized healthcare visits were categorized by the main diagnosis, according to the ICD-10 chapters. AD and dementia were separated to their own category. The number of persons with visits and stays was calculated for every 6 months, irrespective of the frequency of visits/stays individual had during that time window. Furthermore, the relative distribution of the diagnosis categories was computed. Results: AD cohort was more likely to have visits and stays during the 10-year period (OR 1.19, 95% CI 1.17–1.21). The number of persons with visits and stays peaked in AD cohort from 1.5 years before the diagnosis when the differences in relative distribution of different diagnosis categories also became evident. The largest differences were observed for visits/stays with cognitive disorders, symptoms of unspecified diseases and psychiatric disorders diagnoses, and those with missing diagnosis codes in the last time window before AD diagnosis. Conclusions and implications: Increased healthcare service use before AD diagnosis does not seem to arise from differences in specific diagnosis categories of ICD-10 such as diseases of the circulatory system, but from the higher frequency of visits and stays among persons with AD across diagnosis categories. Based on the relative distribution of diagnosis categories, the steep increase in healthcare service use just before and during the diagnostic process is likely due to prodromal symptoms and visits related to cognition. [ABSTRACT FROM AUTHOR]

Background: We examined the prevalence of self-perceived respiratory symptoms (SRS) in the absence of any objective findings of respiratory pathology, and the association of such prevalence with psychological factors and healthcare use in the general population. Methods: The study was conducted among a nationally representative sample of Finnish adults (BRIF8901). Respiratory functioning was measured by a spirometry test. Structured questionnaires were used to measure SRS, physician visits and psychological factors of alexithymia, sense of coherence, illness worry and common mental disorders. Individuals with a diagnosed respiratory disease or a severe psychiatric disorder, determined in a diagnostic interview, were excluded, giving a sample comprising 4544 participants. Results: Twenty-six per cent of the general population and 36% of those with no diagnosed severe psychiatric disorder or respiratory disease experienced SRS despite a normal spirometry result. Psychological factors were associated with SRS (0.0001 < p < 0.032), and on the number of physician visit explaining 42.7% of the difference in visits between individuals with and without SRS, respectively. Illness worry was associated most strongly with SRS [odds ratio (OR) 1.29, 95% confidence interval (CI) 1.19–1.41, p < 0.0001] and higher numbers of physician visits (OR 1.35, CI 1.32–1.38, p < 0.00001), even after several adjustments. Conclusions: Respiratory symptoms without objective findings are common in the general population. The study results underline the role of psychological factors in the reporting of respiratory symptoms and the associated medical burden, thereby indicating the functional nature of the symptomatology. [ABSTRACT FROM AUTHOR]

This article examines the association between healthcare use and receipt of social assistance. It focuses on asking to what extent the use of healthcare (seen as a proxy for health status) leads to social assistance. This is answered by describing the use of healthcare services among a cohort of Finnish social assistance clients before, during and after the first receipt of benefit by means of fixed-effects logistic regression. Using register data, the study follows a group of social assistance recipients from 2005 to 2011 and compares their use of healthcare to those not claiming social assistance during this same period and analyses how their use of health services develops over time. The results show that recipients use public healthcare clearly more than non-recipients, but they do so already prior to the first social assistance receipt. This partly confirms the social selection hypothesis according to which health problems lead to low income. However, the results do not exclude the existence of social causation. The causality is most likely bi-directional. The findings of the descriptive analyses are corroborated by a fixed-effects logistic regression analysis: the use of healthcare services increases the probability of receiving social assistance in the following month. [ABSTRACT FROM AUTHOR]