Parental income gradients in child and adolescent mortality: Norwegian trends over half a century

publishedVersio

Changes in life expectancy and disease burden in Norway, 1990–2019: an analysis of the Global Burden of Disease Study 2019

Bill & Melinda Gates FoundationpublishedVersio

Multiple sclerosis and the labor market

Background: In young adults at the height of their economical activity, multiple sclerosis (MS) is the most common disabling neurological disease. From prior research it has been established that MS has vast effects on labor market participation. However, there is a lack of studies investigating the pattern of transitions MS patients make between labor market states. Objective: To investigate the variation in transitions to sickness absence (SA), rehabilitation (REHAB), disability pension (DP) and return to work (RTW) relative to time with MS. Method: A Cox proportional hazard rate model for single events is used to study the transition to DP for the Oslo cohort dataset, accounting for the relative impacts of age at onset of disease, type of MS and gender. A competing risk hazard rate model for multiple events is used to study transitions to SA, REHAB, DP and RTW for the FD-Trygd dataset, consisting of MS patients as well as matched control subjects. We account for the impact of time with MS as well as for those of age, gender, education, development over 1992-2008, seasonal dependence and duration dependence for transitions from SA and REHAB spells. Results: MS has profound impacts on the transitions RTW, SA, REHAB and DP, which are consistently associated with poorer relative outcomes than those of controls. We find substantial effects and differences in intensity of transitions over time. After 17 years approximately 2/3rds of MS patients end up receiving DP, and only a quarter remain working. We uncover variation towards transitions in the age of the subject, the age at onset of MS (only DP), gender, education level, type of MS (only DP), and time with MS. Transition intensities also vary according to season of the year and according to duration of SA and REHAB spell. We find indication that not only onset of MS but also registration of MS with public authorities has profound impacts on the transitions to the various outcome states. Conclusion: We find that MS patients move dynamically from a start in the state working towards disability pension through spells of SA and REHAB, after onset of disease. Associated with each SA and REHAB spell are the transitions back to work from where they can experience new spells. In between the starting point in the state of working and the final end-point of disability pension MS patients experience different periods that vary in transition-intensity

Future disease-specific health spending and burden of disease in Norway, 2019 to 2040

The expected increase in the proportion of elderly, with increasing rates of chronic diseases, presents a challenge to the Norwegian healthcare system. In this study, we project the future burden of disease and health spending by health conditions from 2019 to 2040; and explore the importance of 1) population growth, 2) population composition, and 3) future epidemiological development for these projections. We find that total, and per capita, health spending is projected to increase in three scenarios (reference, better and worse health) from 2020 to 2040 for communicable diseases, non-communicable diseases, and injuries. The increased proportion of elderly drives the increase in health spending. When keeping the age composition constant (and by this account for the increased proportion of elderly), we find that per capita health spending decreases in the reference and better health scenario but not in the worse-health scenario. If Norway aims to provide care at current levels in the future, substantial reductions in the cost of care is needed. If not, increased health spending is inevitable, due to chronic conditions in old age

Educational attainment and differences in relative survival after acute myocardial infarction in Norway: a registry-based population study

Background Although there is a broad societal interest in socioeconomic differences in survival after an acute myocardial infarction, only a few studies have investigated how such differences relate to the survival in general population groups. We aimed to investigate education-specific survival after acute myocardial infarction and to compare this with the survival of corresponding groups in the general population. Methods Our study included the entire population of Norwegian patients admitted to hospitals for acute myocardial infarction during 2008–2010, with a 6- year follow-up period. Patient survival was measured relative to the expected survival in the general population for three educational groups: primary, secondary and tertiary. Education, sex, age and calendar year-specific expected survival were obtained from population life tables and adjusted for the presence of infarction-related mortality. Results Six-year patient survivals were 56.3% (55.3–57.2) and 65.5% (65.6–69.3) for the primary and tertiary educational groups (95% CIs), respectively. Also 6-year relative survival was markedly lower for the primary educational group: 70.2% (68.6–71.8) versus 81.2% (77.4–84.4). Throughout the follow-up period, patient survival tended to remain lower than the survival in the general population with the same educational background. Conclusion Both patient survival and relative survival after acute myocardial infarction are positively associated with educational level. Our findings may suggest that secondary prevention has been more effective for the highly educated

Disease-specific health spending by age, sex, and type of care in Norway: a national health registry study

Abstract Background Norway is a high-income nation with universal tax-financed health care and among the highest per person health spending in the world. This study estimates Norwegian health expenditures by health condition, age, and sex, and compares it with disability-adjusted life-years (DALYs). Methods Government budgets, reimbursement databases, patient registries, and prescription databases were combined to estimate spending for 144 health conditions, 38 age and sex groups, and eight types of care (GPs; physiotherapists & chiropractors; specialized outpatient; day patient; inpatient; prescription drugs; home-based care; and nursing homes) totaling 174,157,766 encounters. Diagnoses were in accordance with the Global Burden of Disease study (GBD). The spending estimates were adjusted, by redistributing excess spending associated with each comorbidity. Disease-specific DALYs were gathered from GBD 2019. Results The top five aggregate causes of Norwegian health spending in 2019 were mental and substance use disorders (20.7%), neurological disorders (15.4%), cardiovascular diseases (10.1%), diabetes, kidney, and urinary diseases (9.0%), and neoplasms (7.2%). Spending increased sharply with age. Among 144 health conditions, dementias had the highest health spending, with 10.2% of total spending, and 78% of this spending was incurred at nursing homes. The second largest was falls estimated at 4.6% of total spending. Spending in those aged 15–49 was dominated by mental and substance use disorders, with 46.0% of total spending. Accounting for longevity, spending per female was greater than spending per male, particularly for musculoskeletal disorders, dementias, and falls. Spending correlated well with DALYs (Correlation r = 0.77, 95% CI 0.67–0.87), and the correlation of spending with non-fatal disease burden (r = 0.83, 0.76–0.90) was more pronounced than with mortality (r = 0.58, 0.43–0.72). Conclusions Health spending was high for long-term disabilities in older age groups. Research and development into more effective interventions for the disabling high-cost diseases is urgently needed

Variations and determinants of mortality and length of stay of very low birth weight and very low for gestational age infants in Seven European Countries

The EuroHOPE very low birth weight and very low for gestational age infants study aimed to measure and explain variation in mortality and length of stay (LoS) in the populations of seven European nations (Finland, Hungary, Italy (only the province of Rome), the Netherlands, Norway, Scotland and Sweden). Data were linked from birth, hospital discharge and mortality registries. For each infant basic clinical and demographic information, infant mortality and LoS at 1 year were retrieved. In addition, socio-economic variables at the regional level were used. Results based on 16 087 infants confirm that gestational age and Apgar score at 5 min are important determinants of both mortality and LoS. In most countries, infants admitted or transferred to third-level hospitals showed lower probability of death and longer LoS. In the metaanalyses, the combined estimates show that being male, multiple births, presence of malformations, per capita income and low population density are significant risk factors for death. It is essential that national policies improve the quality of administrative datasets and address systemic problems in assigning identification numbers at birth. European policy should aim at improving the comparability of data across jurisdictions

Correction: Mortality and Length of Stay of Very Low Birth Weight and Very Preterm Infants: A EuroHOPE Study.

[This corrects the article DOI: 10.1371/journal.pone.0131685.]

Mortality and Length of Stay of Very Low Birth Weight and Very Preterm Infants: A EuroHOPE Study

The objective of this paper was to compare health outcomes and hospital care use of very low birth weight (VLBW), and very preterm (VLGA) infants in seven European countries. Analysis was performed on linkable patient-level registry data from seven European countries between 2006 and 2008 (Finland, Hungary, Italy (the Province of Rome), the Netherlands, Norway, Scotland, and Sweden). Mortality and length of stay (LoS) were adjusted for differences in gestational age (GA), sex, intrauterine growth, Apgar score at five minutes, parity and multiple births. The analysis included 16,087 infants. Both the 30-day and one-year adjusted mortality rates were lowest in the Nordic countries (Finland, Sweden and Norway) and Scotland and highest in Hungary and the Netherlands. For survivors, the adjusted average LoS during the first year of life ranged from 56 days in the Netherlands and Scotland to 81 days in Hungary. There were large differences between European countries in mortality rates and LoS in VLBW and VLGA infants. Substantial data linkage problems were observed in most countries due to inadequate identification procedures at birth, which limit data validity and should be addressed by policy makers across Europe.Funding Agencies|European Union 7th Framework Programme European Health Care Outcomes, Performance and Efficiency (EuroHOPE) [241721]</p

Changes in life expectancy and disease burden in Norway, 1990–2019: An analysis of the Global Burden of Disease Study 2019

Background: Geographical differences in health outcomes are reported in many countries. Norway has led an active policy aiming for regional balance since the 1970s. Using data from the Global Burden of Disease Study (GBD) 2019, we examined regional differences in development and current state of health across Norwegian counties. Methods: Data for life expectancy, healthy life expectancy (HALE), years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) in Norway and its 11 counties from 1990 to 2019 were extracted from GBD 2019. County-specific contributors to changes in life expectancy were compared. Inequality in disease burden was examined by use of the Gini coefficient. Findings: Life expectancy and HALE improved in all Norwegian counties from 1990 to 2019. Improvements in life expectancy and HALE were greatest in the two counties with the lowest values in 1990: Oslo, in which life expectancy and HALE increased from 71·9 years (95% uncertainty interval 71·4–72·4) and 63·0 years (60·5–65·4) in 1990 to 81·3 years (80·0–82·7) and 70·6 years (67·4–73·6) in 2019, respectively; and Troms og Finnmark, in which life expectancy and HALE increased from 71·9 years (71·5–72·4) and 63·5 years (60·9–65·6) in 1990 to 80·3 years (79·4–81·2) and 70·0 years (66·8–72·2) in 2019, respectively. Increased life expectancy was mainly due to reductions in cardiovascular disease, neoplasms, and respiratory infections. No significant differences between the national YLD or DALY rates and the corresponding age-standardised rates were reported in any of the counties in 2019; however, Troms og Finnmark had a higher age-standardised YLL rate than the national rate (8394 per 100 000 [95% UI 7801–8944] vs 7536 per 100 000 [7391–7691]). Low inequality between counties was shown for life expectancy, HALE, all level-1 causes of DALYs, and exposure to level-1 risk factors. Interpretation: Over the past 30 years, Norway has reduced inequality in disease burden between counties. However, inequalities still exist at a within-county level and along other sociodemographic gradients. Because of insufficient Norwegian primary data, there remains substantial uncertainty associated with regional estimates for non-fatal disease burden and exposure to risk factors