Preparing for the future : the changing demographic composition of hospital patients in Denmark between 2013 and 2050

Funding: Both grants – 2P01AG031719, US National Institute of Health and ”On the edge of societies: Vulnerable populations, emerging challenges for social policies and future demands for social innovation. The experience of the Baltic Sea States (2016-2021)” – were received by Prof. James W. Vaupel, Interdisciplinary Centre on Population Dynamics, University of Southern Denmark (https://portal.findresearcher.sdu.dk/en/persons/jvaupel), who is not a co-author on this paper. The experience of the Baltic Sea States (2016-2021) provided by the Max Planck Society has no number.Background Population aging will pose huge challenges for healthcare systems and will require a promotion of positive attitudes towards older people and the encouragement of careers in geriatrics to attract young professionals into the field and to meet the needs of a rapidly growing number of old-aged patients. We describe the current demographic profile of hospital care use in Denmark and make projections for changes in the patient profile up to 2050. Methods The Danish population in 2013 (N = 5.63 million) was followed up for inpatient and emergency admissions recorded in Danish hospitals in 2013 using population-based registers. We combined age- and sex-specific hospital care use in 2013 with official population estimates to forecast the profile of hospital days up to 2050 with respect to age and sex. Results The total number of hospital days per year is projected to increase by 42% between 2013 and 2050, from 4.66 to 6.72 million days. While small changes are projected for the population aged 0–69, the largest change is projected to occur for the population aged 70+. The 2013 levels were 0.82 and 0.93 million days for men and women aged 70+, respectively. By 2050, these levels are projected to have reached 1.94 and 1.84 million days. While the population aged 70+ accounted for 37.5% of all days in 2013, its contribution is projected to increase to 56.2% by 2050. Conclusion Our study shows one possible scenario for changes in the hospital days due to population aging by 2050: Assuming no changes in hospital care use over the forecast period, the absolute contribution of individuals aged 70+ to the total hospital days will more than double, and the relative contribution of persons aged 70+ will account for nearly 60% of all hospital days by 2050, being largest among men.Publisher PDFPeer reviewe

Heritability and Familial Aggregation of Diverticular Disease: A Population-Based Study of Twins and Siblings

BACKGROUND & AIMS: Little is known about the role of heritable factors in diverticular disease. We evaluated the contribution of heritable factors to the development of diverticular disease diagnosed at a hospitalization or outpatient visit. METHODS: Using nationwide patient registries, we identified 142,123 incident cases of diverticular disease diagnosed at a hospitalization (1977-2011) or an outpatient hospital visit (1995-2011) in Denmark, including cases in 10,420 index siblings and 923 twins. We calculated standardized incidence ratios for siblings versus the general population and concordance rates for monozygotic versus dizygotic twin pairs as measures of relative risk (RR). RESULTS: The RR for diverticular disease in siblings of index cases was 2.92 (95% confidence interval [CI], 2.50-3.39) compared with the general population. The RRs were similar irrespective of the sex of the sibling or index case and were particularly strong in siblings of hospitalized cases and cases that underwent surgery. The proband-wise concordance rate for monozygotic twins was double that of dizygotic twins (0.16 [95% CI, 0.11-0.22] vs 0.07 [95% CI, 0.05-0.11], respectively). The RR of diverticular disease in one twin when the other had diverticular disease was 14.5 (95% CI, 8.9-23) for monozygotic twins compared with 5.5 (95% CI, 3.3-8.6) for dizygotic twins. Associations were stronger in female monozygotic twins compared with male twins (tetrachoric correlation, 0.60 [95% CI, 0.49-0.70] vs 0.33 [95% CI, 0.13-0.51]; P = .03 in an analysis stratified by sex and zygosity). We estimate that 53% (95% CI, 45%-61%) of susceptibility to diverticular disease results from genetic factors. CONCLUSIONS: Based on a population-based study in Denmark, genetic factors appear to contribute to development of diverticular disease

Development and Validation of an OMERACT MRI Whole-Body Score for Inflammation in Peripheral Joints and Entheses in Inflammatory Arthritis (MRI-WIPE)

Objective: To develop a whole-body MRI-scoring system for peripheral arthritis and enthesitis. Methods: After consensus on definitions/locations of MRI pathologies, four multi-reader exercises were performed. Eighty-three joints were scored 0-3 separately for synovitis and osteitis, thirty-three entheses 0-3 separately for soft tissue inflammation and osteitis. Results: In the last exercise, reliability was moderate-good for musculoskeletal radiologists and rheumatologists with previously demonstrated good scoring proficiency. Median pairwise single-measure/average-measure ICCs were 0.67/0.80 for status scores and 0.69/0.82 for change scores; kappas ranged 0.35-0.77. Conclusion: WBMRI scoring of peripheral arthritis and enthesitis is reliable which encourages further testing and refinement in clinical trials

The Literary Old Age at the Intersection of Medical Practice and Public Health—A Cross-Disciplinary Reading of Ane Riel’s <i>Clockwork</i>

Recent decades have witnessed the coming of age of ‘literary gerontology’, a discipline situated at the intersection of literary studies and gerontology. A key argument of this research is that literature and literary criticism can highlight the complexities and ambiguities of age, ageing and later life. As such, the discipline insists on the relevance of literature within the field of gerontology. This study explores this claim from an interdisciplinary perspective and presents the key findings of an exploratory collaboration between researchers representing literature studies, anthropology, history, public health and medicine. The members of the research team took part in a joint reading, analysis and discussion of Danish author Ane Riel’s novel, Clockwork, which depicts an ageing protagonist’s reconcilement with old age and death. These efforts resulted in dual dimensions of insight: a realistic dimension, which may be interpreted as a confirmation of the existing knowledge of ageing and wellbeing, characterized by physical and cognitive challenges; and an imaginary dimension, a type of knowledge distilled in the interaction between the reader and the literary work. The reader can be seen to be tasked with identifying with the protagonist, with this process providing a hitherto unknown perspective on how ageing is experienced, how it feels and what it means. The study exemplifies an approach fostering cross-disciplinary inspiration, which may stimulate novel research hypotheses and ultimately inform public health thinking and medical practice

Joint and entheseal inflammation in the knee region in spondyloarthritis - reliability and responsiveness of two OMERACT whole-body MRI scores.

To perform region-based development of whole-body MRI through validation of knee region scoring systems in spondyloarthritis (SpA). Assessment of knee inflammatory pathologies using 2 systems, OMERACT MRI Whole-body score for Inflammation in Peripheral joints and Entheses (MRI-WIPE) and Knee Inflammation MRI Scoring System (KIMRISS), in 4 iterative multi-reader exercises. In the final exercise, reliability was mostly good for readers with highest agreement in previous exercise. Median pairwise single-measure ICCs for osteitis and synovitis/effusion status/change were 0.71/0.48 (WIPE-osteitis), 0.48/0.77 (WIPE-synovitis/effusion), 0.59/0.91 (KIMRISS-osteitis) and 0.92/0.97 (KIMRISS-synovitis/effusion). SRMs were 0.74 (WIPE-synovitis/effusion) and 0.78 (KIMRISS-synovitis/effusion). MRI-WIPE and KIMRISS may both be useful in SpA whole-body evaluation studies