Chair: Leena Forma and Mari Aaltonen

Given the ageing of population and the care system reforms in the Nordic countries, population based research is needed on ageing, health and on care service systems. The Nordic countries are known from their extensive and reliable registers on population, health and social care. The objective of this symposium is to highlight the advantages of register-based data in research on health and care in ageing societies. The five papers outline the ways in which register data are used in Denmark, Finland, Norway and Sweden. They provide new information on a) the use and costs of services, b) the impact of the care reforms on the use of care, and c) the differences in health and care between age and socioeconomic groups over time.

S7.6.1 Health care use among older adults with and without multimorbidity before and after the primary care reform in Stockholm County Council

Jonas W Wastesson¹, Janne Agerholm², Bo Burström²

¹Aging Research Center, Karolinska Institutet, Sweden, ²Department of Public Health Sciences, Karolinska Institutet, Sweden  

Background: In 2008 a primary care reform was introduced in Stockholm County introducing free choice of provider. Evaluations of the reform have suggested it lead to larger increases in number of visits to general practitioners (GPs) among healthier people in the general population. However, little is known about the specific effect on older adults with multimorbidity.  Methods: Healthcare registers from Stockholm County was used to obtain data on visits to GPs and nurses in primary care and avoidable hospitalizations for the total population aged ?65 years before and after the reform; 2007 (n=294,608) and 2011 (n=335,528). Results: Preliminary analyses suggest that number of annual visits to GPs and nurses increased with 30% and 51% respectively. The increase in number of visits was relatively smaller for older adults with multimorbidity. Among the oldest old, men with multimorbidity increased 44% less than those without multimorbidity. Conclusions: The use of primary care services increased in the older population after the primary care reform. This increase was less pronounced in people with multiple chronic conditions; however, it did not have repercussions on the rates of avoidable hospitalizations. The joint impact of very old age and dementia on long-term care use in last five years of life – nationwide register based study from the years 1996-2013 in Finland.

S7.6.2 The joint impact of very old age and dementia on long-term care use in last five years of life – nationwide register based study from the years 1996-2013 in Finland

Mari Aaltonen¹, Leena Forma¹, Jutta Pulkki¹, Jani Raitanen^1,2, Pekka Rissanen^1,3, Marja Jylhä¹

¹University of Tampere, Finland, ²UKK Institute for Health Promotion, Tampere, Finland,

³National Institute for Health and Welfare, Finland

Background: The increase in longevity contributes to an increase in dementia as a cause of death. This study explores to what extent the increase in the number of very old people and those with dementia in the last years of life influences long-term care (LTC) use. Methods: Register data were linked from the Causes of Death Register and the Register for Health Care and the Register for Social Care of all people who died aged ?70 in 2007 or in 2013 and a 40% random sample of those who died in 2001. Care use each day during the last five years of life was followed. Results: The proportion of people ?80 with dementia was the most rapidly increasing group. They were the most likely users of LTC. Use of LTC decreased in this group from 1996-2001 to 2008-2013, while the days lived at home increased. Due to the increase in the number of persons who were very old and had dementia, the total use of LTC increased. Conclusions: The results suggest an increase in a) the oldest with dementia, who add to the number of those who need LTC and b) the oldest with dementia living at home in the last years of their life.

S7.6.3 Health and care costs by age, gender and proximity to death

Jorid Kalseth, Kjartan Anthun

SINTEF Technology and society, Trondheim, Norway

Background: Population aging is paralleled with concerns of escalating health and long-term care costs. The aim of this study was to take advantage of register data to calculate estimates on health (HC) and long-term care (LTC) costs and describe the distribution of costs by type of care, age group and proximity to death. Methods: Data on service use for the entire population in Norway from four national registers (NPR, KUHR, IPLOS, NorPD) was linked with data from the Cause of Death Registry (DÅR). Costs were calculated using estimates on unit costs. Per capita costs were calculated using population data from Statistic Norway and data on number of deaths from DÅR. Expected Results: Preliminary results show that total per capita costs increase with age among elderly. The substantial increase in costs in high age relates to higher LTC costs; increase in HC costs by age reverses to a decrease among the oldest old. Costs per decedents in the last year of life (last 365 days) are higher than per capita costs among people living at least two years after year of observation for all ages, but the difference decreases with age. HC cost also decrease with age among the elderly decedents, starting at an earlier age than among survivors.

S7.6.4 Socioeconomic differences in revascularizations in Finland and Sweden

Jutta Pulkki, Janne Agerholm¹, Martti Arffman³, Bo Burström², Ilmo Keskimäki³

¹University of Tampere, Finland, ²Department of Public Health Sciences, Karolinska Institutet, Sweden  

³National Institute for Health and Welfare, Finland

Background: Socioeconomic differences in coronary revascularizations are consistent in several countries. As older people are often excluded from these studies little is known about the socioeconomic differences among them. Socioeconomic differences among old people need to be studied in order to ensure equal access to specialized health care for old people in ageing societies. Objectives: The detailed research questions are: To what extent coronary revascularization rates differ between socioeconomic groups among old people in Finland and Sweden, and how the socioeconomic differences change in time in Finland and Sweden? Methods: Socioeconomic differences in revascularizations among people aged 65 and older are followed from 1998 to 2014 in Finland and Sweden by using register data. Data consist of all people (aged 40 and older) who were hospitalised due to ischemic heart disease in Capital regions of these countries. Revascularizations are identified by using the NCSP codes. Indicators for SES are education, family net income, and living alone. Expected results: Socioeconomic disparities in care appear in both countries, but in Finland they are most evident. Relative inequities persist over time, while absolute inequities diminish.

S7.6.5 Income drops and permanent income over 29 years of adult life and inflammation in later life

Jolene Masters Pedersen^1,2, Erik Lykke Mortensen^2,3, Else Foverskov^1,2, Gitte Lindved Petersen^1,2, Rikke Lund^1,2

¹ University of Copenhagen, Denmark, ²Center for Healthy Aging, University of Copenhagen, Denmark, ³University of Copenhagen, Copenhagen, Denmark

Background: Inflammatory processes have been implemented in a host of age related diseases, and are likely mechanisms linking low income with cardiovascular disease. The current study aims to address if annual income drops and permanent income across 29 years are associated with later inflammation. Methods: The study is based on the Copenhagen Aging and Midlife Biobank (n=5,460) with annual measures of personal income from Danish registers. Income drops were defined as a 20% drop in income during one year and permanent income was defined as mean income over 29 years. The associations were estimated using ordinary least square regression, controlling for age, sex, cohort, and education.  Inflammation marked by C-Reactive protein (CRP) and Interleukin-6 (IL-6) was measured at mean age 54 years. Results: We found that 42% of the population experienced at least four income drops over 29 years and the average annual permanent income was 58,900 USD. Each additional drop in income was associated with a 1% higher level of CRP and IL-6. Each 20% increase in permanent income was associated with a 3% decrease in CRP and 2% decrease in IL-6.  Conclusions: The results suggest that income instability over adult life may be associated with higher levels of inflammation in later life.