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Ebdrup NH, Riis AH, Ramlau-Hansen CH, Bay B, Lyngsø J, Rytter D, Jørgensen MJ, Knudsen UB. Healthcare Use in the Five Years Before a First Infertility Diagnosis: A Danish Register-Based Case–Control Study in the CROSS-TRACKS Cohort. Clin Epidemiol 2022; 14:677-688. [PMID: 35586868 PMCID: PMC9109896 DOI: 10.2147/clep.s360292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 04/25/2022] [Indexed: 11/26/2022] Open
Abstract
Purpose Infertility may affect somatic and mental health later in life. Nevertheless, health status before diagnosed infertility is sparsely studied in women. We aimed to describe healthcare use in primary and secondary care before a first infertility diagnosis and compare use between cases and controls. Materials and Methods The case–control study was based on register data and used incidence density sampling. From the CROSS-TRACKS Cohort, we included women residing in the Horsens area in Denmark in 2012–2018 (n = 54,175). Eligible women were aged 18–40 years, nulliparous, and living in heterosexual relationships. Cases were women with a first infertility diagnosis in the Danish National Patient Registry (index date). Five controls were matched on age, birth year, and calendar time. Through linkage to Danish national health registries, we identified general practitioner (GP) attendance, paraclinical examinations, hospital contacts, diagnoses, and redeemed prescriptions. Healthcare use from one year to five years before index date was compared with conditional logistic regression. Results We identified 711 cases and 3555 controls. At one year before index date, cases consulted their GP (odds ratio (OR) = 5.2, 95% confidence interval (CI): 3.2, 8.3) and visited hospital (OR = 1.2, 95% CI: 1.0, 1.4) and redeemed prescriptions (OR = 2.3 95% CI: 1.9, 2.7) more often compared to controls. Cases more often had blood and hemoglobin tests performed, redeemed more drugs related to genitourinary and hormonal diseases, and were more often diagnosed with endocrine and genitourinary diseases in the year before a first infertility diagnosis compared to controls. Cases and controls had comparable healthcare use from five years to one year before a first infertility diagnosis. Conclusion Cases and controls had similar healthcare use from five years to one year before a first infertility diagnosis. However, cases had a higher healthcare use in the year preceding a first infertility diagnosis compared to controls.
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Affiliation(s)
- Ninna Hinchely Ebdrup
- Department of Obstetrics and Gynecology, Fertility Clinic, Horsens Regional Hospital, Horsens, Denmark
- Department of Public Health, Aarhus University, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Correspondence: Ninna Hinchely Ebdrup, Department of Obstetrics and Gynecology, Fertility Clinic, Horsens Regional Hospital, Sundvej 30, Horsens, 8700, Denmark, Tel +45 28 47 21 11, Email
| | - Anders Hammerich Riis
- Department of Research, Regional Hospital Horsens, Horsens, Denmark
- Enversion A/S, Aarhus, Denmark
| | | | - Bjørn Bay
- Department of Obstetrics and Gynecology, Fertility Clinic, Horsens Regional Hospital, Horsens, Denmark
- Maigaard Fertility Clinic, Aarhus, Denmark
| | - Julie Lyngsø
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | - Dorte Rytter
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | | | - Ulla Breth Knudsen
- Department of Obstetrics and Gynecology, Fertility Clinic, Horsens Regional Hospital, Horsens, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Riis AH, Kristensen PK, Petersen MG, Ebdrup NH, Lauritsen SM, Jørgensen MJ. Cohort profile: CROSS-TRACKS: a population-based open cohort across healthcare sectors in Denmark. BMJ Open 2020; 10:e039996. [PMID: 33122323 PMCID: PMC7597526 DOI: 10.1136/bmjopen-2020-039996] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
PURPOSE This paper describes the open cohort CROSS-TRACKS, which comprises population-based data from primary care, secondary care and national registries to study patient pathways and transitions across sectors while adjusting for sociodemographic characteristics. PARTICIPANTS A total of 221 283 individuals resided in the four Danish municipalities that constituted the catchment area of Horsens Regional Hospital in 2012-2018. A total of 96% of the population used primary care, 35% received at least one transfer payment and 66% was in contact with a hospital at least once in the period. Additional clinical information is available for hospital contacts (eg, alcohol intake, smoking status, body mass index and blood pressure). A total of 23% (n=8191) of individuals aged ≥65 years had at least one potentially preventable hospital admission, and 73% (n=5941) of these individuals had more than one. FINDINGS TO DATE The cohort is currently used for research projects in epidemiology and artificial intelligence. These projects comprise a prediction model for potentially preventable hospital admissions, a clinical decision support system based on artificial intelligence, prevention of medication errors in the transition between sectors, health behaviour and sociodemographic characteristics of men and women prior to fertility treatment, and a recently published study applying machine learning methods for early detection of sepsis. FUTURE PLANS The CROSS-TRACKS cohort will be expanded to comprise the entire Central Denmark Region consisting of 1.3 million residents. The cohort can provide new knowledge on how to best organise interventions across healthcare sectors and prevent potentially preventable hospital admissions. Such knowledge would benefit both the individual citizen and society as a whole.
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Affiliation(s)
- Anders Hammerich Riis
- Department of Research, Horsens Regional Hospital, Horsens, Denmark
- Enversion A/S, Aarhus, Denmark
| | - Pia Kjær Kristensen
- Department of Research, Horsens Regional Hospital, Horsens, Denmark
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Ninna Hinchely Ebdrup
- Department of Research, Horsens Regional Hospital, Horsens, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Simon Meyer Lauritsen
- Enversion A/S, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Borregaard B, Dahl JS, Ekholm O, Fosbøl E, Riber LPS, Sibilitz KL, Pedersen SM, Rothberg TPH, Nielsen MH, Berg SK, Møller JE. Employment status before and after open heart valve surgery: A cohort study. PLoS One 2020; 15:e0240210. [PMID: 33027303 PMCID: PMC7541055 DOI: 10.1371/journal.pone.0240210] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 09/23/2020] [Indexed: 12/25/2022] Open
Abstract
Objective Detachment from the workforce following open heart valve surgery is a burden for the patient and society. The objectives were to examine patterns of employment status at different time points and to investigate factors associated with a lower likelihood of returning to the workforce within six months. Methods A cohort study of patients aged 18–63 undergoing valvular surgery at a Danish tertiary centre from 2013–2017. Return to the workforce was defined as being employed, unemployed (still capable of working) or receiving paid leave of absence. The association between demographic-, clinical characteristics (including a surgical risk evaluation, EuroScore), and return to the workforce were investigated with a multivariable logistic regression model. Results In total, 1,395 consecutive patients underwent surgery, 347 were between 18 and 63 years and eligible for inclusion. Of those, 282 were attached to the workforce before surgery and included in the study. At the time of surgery, 79% were on paid sick leave. After six months, 21% of the patients (being part of the workforce before surgery), were still on sick leave. In the regression model, prolonged sick leave prior to surgery (OR 0.43, 95% CI 0.23–0.79) and EuroScore ≥ 2.3 (OR 0.39, 95% CI 0.21–0.74) significantly reduced the likelihood of returning to the workforce. Conclusion One-fifth of patients in the working-age were on sick leave six months after surgery. Prolonged sick leave prior to surgery and a EuroScore ≥2.3 were associated with a lower likelihood of returning to the workforce.
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Affiliation(s)
- Britt Borregaard
- Department of Cardiothoracic and Vascular Surgery, Odense University Hospital, Odense, Denmark
- OPEN, Odense Patient Data Explorative Network, Odense University Hospital, Odense, Denmark
- Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
- Department of Cardiology, Odense University Hospital, Odense, Denmark
- * E-mail:
| | - Jordi S. Dahl
- Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Ola Ekholm
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Emil Fosbøl
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Lars P. S. Riber
- Department of Cardiothoracic and Vascular Surgery, Odense University Hospital, Odense, Denmark
- Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Kirstine L. Sibilitz
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Sasja M. Pedersen
- Faculty of Business and Social Sciences, University of Southern Denmark, Odense, Denmark
| | - Thomas P. H. Rothberg
- Faculty of Business and Social Sciences, University of Southern Denmark, Odense, Denmark
| | - Maiken H. Nielsen
- Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Selina K. Berg
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jacob E. Møller
- Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
- Department of Cardiology, Odense University Hospital, Odense, Denmark
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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Bitsch BL, Nielsen CV, Stapelfeldt CM, Lynggaard V. Effect of the patient education - Learning and Coping strategies - in cardiac rehabilitation on return to work at one year: a randomised controlled trial show (LC-REHAB). BMC Cardiovasc Disord 2018; 18:101. [PMID: 29783942 PMCID: PMC5963181 DOI: 10.1186/s12872-018-0832-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 05/07/2018] [Indexed: 01/21/2023] Open
Abstract
Background Personal resources are identified as important for the ability to return to work (RTW) for patients with ischaemic heart disease (IHD) or heart failure (HF) undergoing cardiac rehabilitation (CR). The patient education ‘Learning and Coping’ (LC) addresses personal resources through a pedagogical approach. This trial aimed to assess effect of adding LC strategies in CR compared to standard CR measured on RTW status at one-year follow-up after CR. Methods In an open parallel randomised controlled trial, patients with IHD or HF were block-randomised in a 1:1 ratio to the LC arm (LC plus CR) or the control arm (CR alone) across three Danish hospital units. Eligible patients were aged 18 to ≤60 and had not left the labour market. The intervention was developed from an inductive pedagogical approach consisting of individual interviews and group based teaching by health professionals with experienced patients as co-educators. The control arm consisted of deductive teaching (standard CR). RTW status was derived from the Danish Register for Evaluation of Marginalisation (DREAM). Blinding was not possible. The effect was evaluated by logistic regression analysis and reported as crude and adjusted odds ratios (OR) with 95% confidence interval (CI). Results The population for the present analysis was N = 244 (LC arm: n = 119 versus control arm: n = 125). No difference in RTW status was found at one year across arms (LC arm: 64.7% versus control arm: 68.8%, adjusted odds ratio OR: 0.76, 95% CI: 0.43-1.31). Conclusion Addition of LC strategies in CR showed no improvement in RTW at one year follow-up. Trial registration www.clinicaltrials.gov identifier NCT01668394. First Posted: August 20, 2012.
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Affiliation(s)
- Birgitte Laier Bitsch
- Department of Public Health, Centre for Rehabilitation Research, Aarhus University, P.P. Ørumsgade 11, 1B, 8000, Aarhus C, Denmark.
| | - Claus Vinther Nielsen
- Department of Public Health, Section of Social Medicine and Rehabilitation, Aarhus University, Aarhus, Denmark.,DEFACTUM, Central Denmark Region, Aarhus, Denmark
| | - Christina Malmose Stapelfeldt
- Department of Public Health, Section of Social Medicine and Rehabilitation, Aarhus University, Aarhus, Denmark.,DEFACTUM, Central Denmark Region, Aarhus, Denmark
| | - Vibeke Lynggaard
- Cardiovascular Research Unit, Department of Cardiology, Regional Hospital West Jutland, Herning, Denmark
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Hansen TB, Zwisler AD, Berg SK, Sibilitz KL, Thygesen LC, Doherty P, Søgaard R. Exercise-based cardiac rehabilitation after heart valve surgery: cost analysis of healthcare use and sick leave. Open Heart 2015; 2:e000288. [PMID: 26301099 PMCID: PMC4538388 DOI: 10.1136/openhrt-2015-000288] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 06/16/2015] [Accepted: 06/22/2015] [Indexed: 01/05/2023] Open
Abstract
Background Owing to a lack of evidence, patients undergoing heart valve surgery have been offered exercise-based cardiac rehabilitation (CR) since 2009 based on recommendations for patients with ischaemic heart disease in Denmark. The aim of this study was to investigate the impact of CR on the costs of healthcare use and sick leave among heart valve surgery patients over 12 months post surgery. Methods We conducted a nationwide survey on the CR participation of all patients having undergone valve surgery between 1 January 2011 and 30 June 2011 (n=667). Among the responders (n=500, 75%), the resource use categories of primary and secondary healthcare, prescription medication and sick leave were analysed for CR participants (n=277) and non-participants (n=223) over 12 months. A difference-in-difference analysis was undertaken. All estimates were presented as the means per patient (95% CI) based on non-parametric bootstrapping of SEs. Results Total costs during the 12 months following surgery were €16 065 per patient (95% CI 13 730 to 18 399) in the CR group and €15 182 (12 695 to 17 670) in the non-CR group. CR led to 5.6 (2.9 to 8.3, p<0.01) more outpatient visits per patient. No statistically significant differences in other cost categories or total costs €1330 (−4427 to 7086, p=0.65) were found between the groups. Conclusions CR, as provided in Denmark, can be considered cost neutral. CR is associated with more outpatient visits, but CR participation potentially offsets more expensive outpatient visits. Further studies should investigate the benefits of CR to heart valve surgery patients as part of a formal cost-utility analysis.
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Affiliation(s)
- T B Hansen
- Department of Cardiology , Roskilde Hospital , Roskilde , Denmark ; Centre for Applied Health Services Research, University of Southern Denmark , Odense , Denmark ; Department of Cardiology , The Heart Centre, Rigshospitalet, Copenhagen University Hospital , Copenhagen , Denmark
| | - A D Zwisler
- Department of Cardiology , The Heart Centre, Rigshospitalet, Copenhagen University Hospital , Copenhagen , Denmark . ; National Institute of Public Health, University of Southern Denmark , Copenhagen , Denmark ; National Centre of Rehabilitation and Palliation, University of Southern Denmark and University Hospital of Odense , Odense , Denmark
| | - S K Berg
- Department of Cardiology , The Heart Centre, Rigshospitalet, Copenhagen University Hospital , Copenhagen , Denmark
| | - K L Sibilitz
- Department of Cardiology , The Heart Centre, Rigshospitalet, Copenhagen University Hospital , Copenhagen , Denmark
| | - L C Thygesen
- National Institute of Public Health, University of Southern Denmark , Copenhagen , Denmark
| | - P Doherty
- Department of Health Sciences , University of York , York , UK
| | - R Søgaard
- Department of Public Health , Aarhus University , Aarhus , Denmark ; Department of Clinical Medicine , Aarhus University , Aarhus , Denmark
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