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

Autoři: Andreas Jensen aff001;  Per Kragh Andersen aff002;  John Sahl Andersen aff003;  Gorm Greisen aff004;  Lone Graff Stensballe aff001
Působiště autorů: Department of Paediatrics and Adolescent Medicine, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark aff001;  Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark aff002;  Section of General Practice, Department of Public Health and Research Unit for General Practice, University of Copenhagen, Copenhagen, Denmark aff003;  Department of Neonatology, Rigshospitalet, Copenhagen University Hospital and the University of Copenhagen, Copenhagen, Denmark aff004
Vyšlo v časopise: PLoS ONE 14(10)
Kategorie: Research Article
doi: 10.1371/journal.pone.0224544



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.


Register-based descriptive study.


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.


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).


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.

Klíčová slova:

Age groups – Death rates – General practitioners – Child health – Inpatients – Neonates – Outpatients – Danish people


1. Lykke C, Ekholm O, Schmiegelow K, et al. All-cause mortality rates and home deaths decreased in children with life-limiting diagnoses in Denmark between 1994 and 2014. Acta Paediatrica, International Journal of Paediatrics. 2018;

2. Statistics Denmark. StatBank Denmark [Internet]. 2018 [cited 2018 Jul 13].

3. Pedersen KM, Andersen JS, Sondergaard J. General Practice and Primary Health Care in Denmark. J Am Board Fam Med. 2012;25(Suppl 1):S34–8.

4. Olejaz M, Juul Nielsen A, Rudkjøbing A, et al. Denmark health system review. Health Syst Transit [Internet]. 2012;14(2):i–xxii, 1–192. 22575801

5. Fadnes LT, Diaz E. Primary healthcare usage and use of medications among immigrant children according to age of arrival to Norway: A population-based study. BMJ Open. 2017;7(2).

6. Videholm S, Silfverdal S-A, Reniers G. Maternal weight and infections in early childhood: a cohort study. Arch Dis Child [Internet]. 2018 Jun 21 [cited 2018 Jul 9];archdischild-2017-314628.

7. Ferro A, Kristiansson PM. Ecology of medical care in a publicly funded health care system: a registry study in Sweden. Scand J Prim Heal Care [Internet]. 2011;29(3):187–92.

8. Almqvist C, Wettermark B, Hedlin G, et al. Antibiotics and asthma medication in a large register-based cohort study—confounding, cause and effect. Clin Exp Allergy. 2012;42(1):104–11. doi: 10.1111/j.1365-2222.2011.03850.x 22092483

9. Lass J, Odlind V, Irs A, et al. Antibiotic prescription preferences in paediatric outpatient setting in Estonia and Sweden. Springerplus. 2013;2(1).

10. Thygesen LC, Daasnes C, Thaulow I, et al. Introduction to Danish (nationwide) registers on health and social issues: structure, access, legislation, and archiving. ScandJPublic Heal. 2011 Jul;39(1403–4948 (Linking)):12–6.

11. Pedersen CB, Gøtzsche H, Møller JØ, et al. The Danish Civil Registration System A cohort of eight million persons. Dan Med Bull. 2006;53:441–9. 17150149

12. Schmidt M, Schmidt SAJ, Sandegaard JL, et al. The Danish National patient registry: A review of content, data quality, and research potential. Vol. 7, Clinical Epidemiology. 2015. p. 449–90.

13. Wallach Kildemoes H, Toft Sørensen H, Hallas J. The Danish national prescription registry. Scand J Public Health. 2011;39(7):38–41.

14. Sahl Andersen J, De Fine Olivarius N, Krasnik A. The Danish National Health Service Register. Scand J Public Health [Internet]. 2011;39(7 Suppl):34–7. 21775348

15. Pottegård A, Schmidt SAJ, Wallach-Kildemoes H, et al. Data resource profile: The Danish national prescription registry. Int J Epidemiol. 2017;46(3):798. doi: 10.1093/ije/dyw213 27789670

16. Johannesdottir SA, Horváth-Puhó E, Ehrenstein V, et al. Existing data sources for clinical epidemiology: The Danish National database of reimbursed prescriptions. Clin Epidemiol. 2012;4(1):303–13.

17. Sundhedsdatastyrelsen. Sundhedsregistre—Data om befolkningens sundhed [Internet]. 2019 [cited 2019 Jul 29].

18. Danmarks Statistik. Grunddataoversigt [Internet]. 2019 [cited 2019 Jul 29].

19. Kristensen K, Hjuler T, Ravn H, et al. Chronic diseases, chromosomal abnormalities, and congenital malformations as risk factors for respiratory syncytial virus hospitalization: a population-based cohort study. Clin Infect Dis. 2012;54(6):810–7. doi: 10.1093/cid/cir928 22247121

20. Yu Y, Qin G, Cnattingius S, et al. Mortality in children aged 0–9 years: A nationwide cohort study from three nordic countries. PLoS One. 2016;11(1).

21. The Capital Region of Denmark. Medical Helpline 1813 [Internet]. [cited 2018 Aug 30].

22. Hofmann B. Diagnosing overdiagnosis: conceptual challenges and suggested solutions. EurJEpidemiol. 2014 Sep;29(1573–7284 (Electronic)):599–604.

23. Aabenhus R, Siersma V, Hansen MP, et al. Antibiotic prescribing in Danish general practice 2004–13. J Antimicrob Chemother. 2016;71(8):2286–94. doi: 10.1093/jac/dkw117 27107098

24. National Board of Health. Ministry of Health [Internet]. 2011 [cited 2018 Sep 3].

25. Hammer-Helmich L, Linneberg A, Thomsen SF, et al. Health service use among children with and without eczema, asthma, and hay fever. Clin Epidemiol. 2016;8:341–9. doi: 10.2147/CLEP.S111960 27695364

26. Henriksen DP, Rasmussen L, Hansen MR, et al. Comparison of the five Danish regions regarding demographic characteristics, healthcare utilization, and medication use—A descriptive cross-sectional study. PLoS One. 2015;10(10).

27. Würtz AM, Rytter D, Vestergaard CH, et al. Prenatal exposure to antiepileptic drugs and use of primary healthcare during childhood: a population-based cohort study in Denmark. BMJ Open [Internet]. 2017 Jan 5 [cited 2018 Jul 9];7(1):e012836. 28069620

28. Kamper-Jørgensen M, Wohlfahrt J, Simonsen J, et al. Temporal trend in paediatric infections in Denmark. Arch Dis Child. 2006;91(5):401–4. doi: 10.1136/adc.2005.085787 16464963

29. Huibers L, Moth G, Andersen M, et al. Consumption in out-of-hours health care: Danes double Dutch? Scand J Prim Health Care. 2014;32(1):44–50. doi: 10.3109/02813432.2014.898974 24635578

Článek vyšel v časopise


2019 Číslo 10