To identify the factual morbidity and mortality of narcolepsy in a controlled design.
National Patient Registry.
All national diagnosed patients (757) with health information at least 3 years prior ...to and after diagnose of narcolepsy.
Randomly selected four citizens (3,013) matched for age, sex, and socioeconomic status from the Danish Civil Registration System Statistics.
Increased morbidity prior to narcolepsy diagnosis included (odds ratio, 95% confidence interval):- diseases of the endocrine, nutritional, and metabolic systems (2.10, 1.32-3.33); nervous system (5.27, 3.65-7.60); musculoskeletal system (1.59, 1.23-2.05); and other abnormal symptoms and laboratory findings (1.66, 1.25-2.22). After the diagnosis, narcolepsy patients experienced diseases of the endocrine, nutritional, and metabolic (2.31, 1.51-3.54), nervous (9.19, 6.80-12.41), musculoskeletal (1.70, 1.28-2.26), eye (1.67, 1.03-2.71), and respiratory systems (1.84, 1.21-2.81). Specific diagnoses were diabetes (2.4, 1,2-4.7, P < 0.01), obesity (13.4, 3.1-57.6, P < 0.001), sleep apnea (19.2, 7.7-48.3, P < 0.001), other sleep disorders (78.5, 11.8-523.3, P < 0.001), chronic obstructive pulmonary disease (2.8, 1.4-5.8, P < 0.01), lower back pain (2.5, 1.4-4.2, P < 0.001), arthrosis/arthritis (2.5, 1.3-4.8, P < 0.01), observation of neurological diseases (3.5, 1.9-6.5, P < 0.001), observation of other diseases (1.7, 1.2-2.5, P < 0.01), and rehabilitation (5.0, 1.5-16.5, P < 0.005). There was a trend towards greater mortality in narcolepsy (P = 0.07).
Patients with narcolepsy present higher morbidity several years prior to diagnose and even higher thereafter. The mortality rate due to narcolepsy was slightly but not significantly higher.
Information regarding welfare consequences of early onset of Borderline Personality Disorder (BPD) is limited. This nationwide study aimed to estimate the educational and employment outcome and ...health care costs of patients with early-onset BPD compared with matched controls. All patients (< 19 years) with first diagnosis of BPD in the Danish Patient Register (NPR) during the period 1983–2015 were included. Health care costs and socioeconomic variables were extracted from national registers. A total of 171 patients was compared with 677 controls. At the age of 20 years, BPD patients had reached a statistically significantly lower educational level (including lower primary school grades) and employment status compared with the controls. When adjusting for the parents’ educational level, BPD patients were nearly 22 times more likely to be unemployed (OR = 21.7, 95% CI 11.9, 39.6), and nearly 15 times more likely to be on disability pension (OR = 14.8, 95% CI 5.0, 43.9) than controls. Furthermore, the total health care costs were more than 8 times higher in the BPD group. Early onset of BPD was associated with lower educational and vocational outcome and increased health care costs as early as at the age of 20 years. Even after controlling for parents’ lower socioeconomic status, the patients have poorer outcome than the control group. This underlines that initiatives to support patients in finishing school and secondary education is highly needed. Future prevention and early intervention programs should target patients with early-onset BPD and their families.
Childhood- and adolescent-onset epilepsy may have a significant impact on long-term educational and vocational status, which in turn has consequences for individuals' socioeconomic status. We ...estimated the factual long-term socioeconomic consequences and healthcare costs of individuals with diagnosed epilepsy.
The prospective cohort study included Danish individuals with epilepsy onset before the age of 18 years, diagnosed between 2002 and 2016. Healthcare costs and socioeconomic data were obtained from nationwide administrative and health registers. The prediction was made with a general estimating equation (GEE). A total of 15,329 individuals were found with the diagnosis during this period and were followed until the age of 30 years. These were compared with 31,414 controls. We used 30 years as this represent an age where most has finalized their education, and as such represent the final educational level. Patients and their controls were subdivided into debut age groups of 0–5 and 6–18 years. Individuals were matched for age, gender, and residential location.
Compared with control groups, patients with epilepsy at the age of 30 years tended to have the following: 1) parents with lower educational attainment; 2) a significantly lower educational level when controlling for parental education attainment; 3) lower grade-point averages; 4) a lower probability of being in employment and lower income, even when transfer payments were considered; and 5) elevated healthcare costs, including those for psychiatric care. It was also noted that the long-term educational consequences for patients with epilepsy were associated with parental educational level. Differences were more pronounced for those with early (0–5 years) rather than later (6–18 years) onset epilepsy.
Epilepsy is associated with severe long-term socioeconomic consequences: lower educational level, school grades, employment status, and earned income. The presence of epilepsy is associated with parental educational level.
1.Register-based study; epilepsy based on diagnosis within the hospital sector; patients found with diagnosis in general practice were not included.2.Some patients treated in the primary sector may not have been identified.3.Parental education level may have risen after the index date when the patient was first included.
•Childhood and adolescent epilepsy are associated with long-term negative impacts on educational level, employment status, and earned income.•Childhood and adolescent epilepsy are associated with long-term healthcare uses, especially for those with early disease onset.•Childhood and adolescent epilepsy are related to lower levels of parental education.
ABSTRACT Objective Most studies have used cardiovascular and cerebrovascular disease (CVD) end-points to measure the effect of continuous positive airway pressure (CPAP), but pre-diagnostic ...morbidities involve a range of comorbidities that may influence the consequences of obstructive sleep apnea (OSA). We therefore aimed to evaluate all-cause total mortality after a diagnosis of OSA, the effect of CPAP in women and men, and the potential effect of major comorbidities. Methods We used national registry data as a historical cohort and included 22,135 OSA patients aged 20 years or more with comorbidity data 3 years before diagnosis and follow-up morbidity and mortality over a period of 17 years. Results A total of 8129 (37%) accepted CPAP for more than 6 months; 14,006 (63%) were CPAP non-user/non-compliant. Those treated with CPAP tended to have higher mortality rates. Patients treated with CPAP were more likely to be male, elderly, suffer from diabetes, and present with more cardiovascular diseases than those not treated with CPAP. After a diagnosis of OSA, more patients in the CPAP-treated group developed cardiovascular complications. Female gender was associated with lower mortality, whereas age, diabetes type 2, and hypertension prior to OSA diagnosis were associated with negative effects on outcome. After an OSA diagnosis, male gender, age, diabetes (types 1 and 2), hypertension, and heart failure were all associated with greater mortality. CPAP treatment had a positive effect in middle-aged and elderly people, whereas CPAP in females had no effect on all-cause mortality. Conclusions CPAP-treated patients present more comorbidities before and after diagnosis compared with non-treated/non-compliant patients, which explains the higher mortality in this group. CPAP treatment is associated with lower mortality rates in middle-aged and elderly (aged 60+ years) males, but only after adjustment for multiple comorbidities. No effect of CPAP treatment on all-cause mortality in female OSA patients was found. Males with OSA, older than 40 years, with comorbidities and a low educational level presented a particularly high mortality risk.
Abstract The objective of the study was to evaluate the morbidities and mortality in a national group of middle-aged and elderly narcolepsy patients before and after the first diagnosis of the ...condition. Methods From the Danish National Patient Registry (NPR), 1174 patients (45.1% males) aged 20-59 years and 339 patients (44.8% males) aged 60+ who received a diagnosis of narcolepsy between 1998 and 2014 were compared, respectively, with 4716 and 1353 control citizens matched for age, gender and geography, who were randomly chosen from the Danish Civil Registration System Statistics. In the NPR, all morbidities are grouped into major WHO classes. Results Middle-aged and elderly patients had more health contacts before and after their narcolepsy diagnosis with respect to several disease domains: infections, neoplasm, endocrine/metabolic diseases/diabetes, mental/psychiatric, neurological (including epilepsy), eye, cardiovascular (hypertension, ischemic heart disease), respiratory (upper-airway infections, sleep apnea), gastrointestinal, musculoskeletal (including discopathies) and skin diseases. Narcolepsy patients had lower reproductive rates. Furthermore, patients showed significantly more health contacts due to the evaluation and control contacts for disease and symptoms. Patients suffered from significantly more multiple diseases than did controls. The 17-year hazard ratio mortality rates were 1.35 (95% CI, 0.94-1.95, p=0.106) among 20-59 year-olds, and 1.38 (1.12-1.69, p=0.002) among those aged 60+ years. Conclusion There are higher rates of morbidity in several disease domains before and after a diagnosis of narcolepsy. Elderly narcolepsy patients have higher mortality rates.
Abstract
In Denmark, a 10-year plan for psychiatry has been agreed on. The content of the plan was developed in collaboration between the Danish Health Authority and the Danish Authority for Social ...Services and Housing, and it involved many stakeholders. Recently, the government presented a planned investment that would increase the overall budget in Danish regions and municipalities by almost 20 percent over a 10-year period. Epidemiological research demonstrating shortened life expectancy and high levels of burden of disease for people with mental disorders contributed to emphasizing the need for improvement of psychiatric services. User organizations, trade unions, and scientific societies in the field of mental health were unified in a common organization, called the Psychiatry Alliance, and this alliance agreed on common action points and acted together to influence politicians. An assertive approach toward politicians and media was pivotal, and being a first mover and presenting tentative budgets was very influential.
Abstract Narcolepsy is associated with significant morbidities. We evaluated the morbidities and mortality in a national group of child and adolescent patients after a first diagnosis of narcolepsy. ...Methods Identified from the Danish National Patient Registry (NPR), 243 patients (128 boys) aged 0-19 years diagnosed with narcolepsy between 1998-2012 with follow-up until 2014 were compared with 970 controls who were randomly chosen from the Danish Civil Registration System Statistics and matched by age, gender and geography. Comorbidities were calculated three years before and after diagnoses. Results In addition to the more frequent health contacts due to neurological diseases, patients showed elevated odds ratios before and after diagnosis of endocrine and metabolic conditions (4.4 (95% CI, 1.9-10.4); 3.8 (1.7-8.4)), nervous disorders (16.6 (8.0-34.4); 198 (49.0-804)), psychiatric illnesses (4.5 (2.3-9.1)/5.8 (2.8-12.1)), pulmonary diseases, and other diseases (3.1 (2.0-4.9); 3.1 (2.0-4.9)). Congenital abnormalities (2.5 (1.1-5.5)), respiratory (2.9 (1.5-5-5)) and eye (5.7 (2.2-15.0)) diseases were more common before diagnosis. Injuries were also more common after diagnosis (1.5 (1.0-2.1)). Narcoleptic children presented significantly more diagnoses of multiple comorbidities than controls before and after diagnosis. Conclusion Morbidity is more frequent in several domains, including metabolic, psychiatric, neurological and other diseases before and after a diagnosis of narcolepsy in children.
Purpose
Patients in intensive care units (ICUs) are at risk of stress-related gastrointestinal (GI) bleeding and stress ulcer prophylaxis (SUP), including proton pump inhibitors, is widely used in ...the attempt to prevent this. In this secondary analysis of Stress Ulcer Prophylaxis in Intensive Care Unit (SUP-ICU) trial, we assessed 1-year outcomes in the pantoprazole vs. placebo groups.
Methods
In the SUP-ICU trial, 3298 acutely admitted ICU patients at risk of GI bleeding were randomly allocated, stratified for site, to pantoprazole or placebo. In this secondary analysis, we assessed clinically important GI bleedings in ICU and 1-year mortality, health care resource use (e.g. readmission with GI bleeding, use of home care and general practitioner), health care costs, and employment status for the Danish participants using registry data.
Results
Among the 2099 Danish participants, 2092 had data in the registries; 1045 allocated to pantoprazole and 1047 to placebo. The number of clinically important GI bleedings in ICU was 1.9 percentage points 95% CI 0.3–3.5 lower in the pantoprazole group vs. the placebo group, but none of the 1-year outcomes differed statistically significantly between groups, including total health care costs (€1954 − 2992 to 6899), readmission with GI bleeding (− 0.005 admissions − 0.016 to 0.005), 1-year mortality (− 0.013 percentage points − 0.051 to 0.026), and employment (− 0.178 weeks − 0.390 to 0.034).
Conclusion
Among ICU patients at risk of GI bleeding, pantoprazole reduced clinically important GI bleeding in ICU, but this did not translate into a reduction in 1-year mortality, health care resource use or improvements in employment status.
Objective: To evaluate the socioeconomic impact of obesity by estimating the direct and indirect costs associated with obesity in Denmark, based on individual level data. Methods: Costs were assessed ...for different BMI groups, and the relative risks for change in direct and indirect costs per BMI point above 30 were estimated. A fourth analysis estimated the odds ratio for comorbidities per BMI point above 30. Individual data on income, social transfer payments, healthcare costs and diagnoses were retrieved from national registries. Results: One BMI point above 30 was associated with a 2% decrease in income, a 3% increase in social transfer payments, and a 4% increase in healthcare costs. In absolute numbers, income contributed to most of the total economic burden. One BMI point above 30 was also associated with increased comorbidity, which explains the increase in both direct and indirect costs. Conclusion: Obesity is associated with increased comorbidity, giving rise to an increase in both direct and indirect costs. Especially income is affected, which emphasizes the importance of including both measures when evaluating the total socioeconomic burden of obesity. Our findings draw attention to the potential for saving public resources and preventing loss of income by preventing obesity.
We evaluated health care costs in patients with childhood onset visual impairment caused by inherited retinal dystrophies (IRD).
The IRD cohort, identified from the Danish Registry of Blind and ...Partially Sighted Children, was compared to age- and sex-matched controls from the national, Danish population registry. Information on health care expenditures for somatic and psychiatric in- and outpatient services, purchase of prescription medications and paid assistance at home were obtained from national registries for the years 2002-2017.
We included 412 in the IRD cohort (6,290 person years) and 1656 (25,088 person years) in the control cohort. Average, annual health care expenditures from age 0-48 years of age were €1,488 (SD 4,711) in the IRD cohort and €1,030 (4,639) in the control cohort. The largest difference was for out-patient eye care (13.26 times greater, 95% confidence interval 12.90-13.64). Psychiatric in-patient expenditures were 1.71 times greater (95% CI 1.66-1.76) in the IRD cohort but psychiatric out-patient health care costs were comparable between groups.
Health care costs were approximately 40% greater in the IRD cohort compared to an age- and sex-matched sample from the general Danish population. This is relevant in the current situation with a number of trials aimed at treating IRDs using genetically based therapies. Although eye care expenditures were many times greater, they made up < 10% of the total health care expenditures even in the IRD cohort. The reduced costs related to injuries in the visually impaired cohort was a surprising finding but may reflect a reduced propensity to seek medical care rather than a reduced risk of injuries.
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