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

by Andreas Jensen, Per Kragh Andersen, John Sahl Andersen, Gorm Greisen, Lone Graff Stensballe

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

Register-based descriptive study.

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.