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      Gender differences in time to first hospital admission at age 60 in Denmark, 1995–2014

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          Abstract

          Women have consistently lower mortality rates than men at all ages and with respect to most causes. However, gender differences regarding hospital admission rates are more mixed, varying across ages and causes. A number of intuitive metrics have previously been used to explore changes in hospital admissions over time, but have not explicitly quantified the gender gap or estimated the cumulative contribution from cause-specific admission rates. Using register data for the total Danish population between 1995 and 2014, we estimated the time to first hospital admission for Danish men and women aged 60. This is an intuitive population-level metric with the same interpretive and mathematical properties as period life expectancy. Using a decomposition approach, we were able to quantify the cumulative contributions from eight causes of hospital admission to the gender gap in time to first hospital admission. Between 1995 and 2014, time to first admission increased for both, men (7.6 to 9.4 years) and women (8.3 to 10.3 years). However, the magnitude of gender differences in time to first admission remained relatively stable within this time period (0.7 years in 1995, 0.9 years in 2014). After age 60, Danish men had consistently higher rates of admission for cardiovascular conditions and neoplasms, but lower rates of admission for injuries, musculoskeletal disorders, and sex-specific causes. Although admission rates for both genders have generally declined over the last decades, the same major causes of admission accounted for the gender gap. Persistent gender differences in causes of admission are, therefore, important to consider when planning the delivery of health care in times of population ageing.

          Supplementary Information

          The online version contains supplementary material available at 10.1007/s10433-021-00614-w.

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          The Danish National Patient Registry: a review of content, data quality, and research potential

          Background The Danish National Patient Registry (DNPR) is one of the world’s oldest nationwide hospital registries and is used extensively for research. Many studies have validated algorithms for identifying health events in the DNPR, but the reports are fragmented and no overview exists. Objectives To review the content, data quality, and research potential of the DNPR. Methods We examined the setting, history, aims, content, and classification systems of the DNPR. We searched PubMed and the Danish Medical Journal to create a bibliography of validation studies. We included also studies that were referenced in retrieved papers or known to us beforehand. Methodological considerations related to DNPR data were reviewed. Results During 1977–2012, the DNPR registered 8,085,603 persons, accounting for 7,268,857 inpatient, 5,953,405 outpatient, and 5,097,300 emergency department contacts. The DNPR provides nationwide longitudinal registration of detailed administrative and clinical data. It has recorded information on all patients discharged from Danish nonpsychiatric hospitals since 1977 and on psychiatric inpatients and emergency department and outpatient specialty clinic contacts since 1995. For each patient contact, one primary and optional secondary diagnoses are recorded according to the International Classification of Diseases. The DNPR provides a data source to identify diseases, examinations, certain in-hospital medical treatments, and surgical procedures. Long-term temporal trends in hospitalization and treatment rates can be studied. The positive predictive values of diseases and treatments vary widely (<15%–100%). The DNPR data are linkable at the patient level with data from other Danish administrative registries, clinical registries, randomized controlled trials, population surveys, and epidemiologic field studies – enabling researchers to reconstruct individual life and health trajectories for an entire population. Conclusion The DNPR is a valuable tool for epidemiological research. However, both its strengths and limitations must be considered when interpreting research results, and continuous validation of its clinical data is essential.
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            The Danish Civil Registration System as a tool in epidemiology.

            The methodological advances in epidemiology have facilitated the use of the Danish Civil Registration System (CRS) in ways not previously described systematically. We reviewed the CRS and its use as a research tool in epidemiology. We obtained information from the Danish Law on Civil Registration and the Central Office of Civil Registration, and used existing literature to provide illustrative examples of its use. The CRS is an administrative register established on April 2, 1968. It contains individual-level information on all persons residing in Denmark (and Greenland as of May 1, 1972). By January 2014, the CRS had cumulatively registered 9.5 million individuals and more than 400 million person-years of follow-up. A unique ten-digit Civil Personal Register number assigned to all persons in the CRS allows for technically easy, cost-effective, and unambiguous individual-level record linkage of Danish registers. Daily updated information on migration and vital status allows for nationwide cohort studies with virtually complete long-term follow-up on emigration and death. The CRS facilitates sampling of general population comparison cohorts, controls in case-control studies, family cohorts, and target groups in population surveys. The data in the CRS are virtually complete, have high accuracy, and can be retrieved for research purposes while protecting the anonymity of Danish residents. In conclusion, the CRS is a key tool for epidemiological research in Denmark.
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              The Danish National Patient Register.

              The Danish National Patient Register (NPR) was established in 1977, and it is considered to be the finest of its kind internationally. At the onset the register included information on inpatient in somatic wards. The content of the register has gradually been expanded, and since 2007 the register has included information on all patients in Danish hospitals. Although the NPR is overall a sound data source, both the content and the definitions of single variables have changed over time. Changes in the organisation and provision of health services may affect both the type and the completeness of registrations. The NPR is a unique data source. Researchers using the data should carefully consider potential fallacies in the data before drawing conclusions.
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                Author and article information

                Contributors
                r.j.seaman@stir.ac.uk
                Journal
                Eur J Ageing
                Eur J Ageing
                European Journal of Ageing
                Springer Netherlands (Dordrecht )
                1613-9372
                1613-9380
                27 March 2021
                27 March 2021
                December 2021
                : 18
                : 4
                : 443-451
                Affiliations
                [1 ]GRID grid.4305.2, ISNI 0000 0004 1936 7988, Institute of Genetics and Molecular Medicine, , University of Edinburgh, ; Edinburgh, UK
                [2 ]GRID grid.419511.9, ISNI 0000 0001 2033 8007, Max Planck Institute for Demographic Research, ; Rostock, Germany
                [3 ]GRID grid.10825.3e, ISNI 0000 0001 0728 0170, Department of Epidemiology, Biostatistics, and Biodemography, , University of Southern Denmark, ; Odense, Denmark
                [4 ]GRID grid.10825.3e, ISNI 0000 0001 0728 0170, Interdisciplinary Centre On Population Dynamics (CPop), , University of Southern Denmark, ; Odense, Denmark
                [5 ]GRID grid.10825.3e, ISNI 0000 0001 0728 0170, Danish Ageing Research Centre, , University of Southern Denmark, ; Odense, Denmark
                [6 ]GRID grid.11918.30, ISNI 0000 0001 2248 4331, University of Stirling, ; Stirling, UK
                Author information
                http://orcid.org/0000-0002-7170-1205
                http://orcid.org/0000-0003-4138-5886
                http://orcid.org/0000-0002-4622-9826
                http://orcid.org/0000-0002-5429-5292
                http://orcid.org/0000-0003-1400-4048
                Article
                614
                10.1007/s10433-021-00614-w
                8563932
                34786008
                e3433cff-b1bb-4768-9e6c-b12876f4d2f2
                © The Author(s) 2021

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

                History
                : 2 March 2021
                Funding
                Funded by: National Institute of Health
                Award ID: P01AG031719
                Award ID: R01AG026786
                Award ID: 2P01AG031719
                Award Recipient :
                Funded by: FundRef http://dx.doi.org/10.13039/100008397, Velux Fonden;
                Funded by: FundRef http://dx.doi.org/10.13039/501100004189, Max-Planck-Gesellschaft;
                Award ID: “On the edge of societies: New vulnerable populations, emerging challenges for social policies and future demands for social innovation and the experience of the Baltic Sea States (2016-2021)”
                Award Recipient :
                Funded by: European Research Council
                Award ID: 716323
                Funded by: Max Planck Institute for Demographic Research (2)
                Categories
                Original Investigation
                Custom metadata
                © Springer Nature B.V. 2021

                Geriatric medicine
                gender differences,hospital admissions,healthcare use,health
                Geriatric medicine
                gender differences, hospital admissions, healthcare use, health

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