Nationwide data on home care and care home residence: presentation of the Swedish Social Service Register, its content and coverage

Aims: All Swedish municipalities are legally obliged to provide publicly funded elder care to individuals in need. The Swedish Social Service Register collects data on such care. It is the only nationwide source of information on care home residency and use of home care but has rarely been used for research. This study aims to present the content and coverage of the Social Service Register and to provide guidance for researchers planning to use these data. Methods: For each month between 2013 and 2020, we examined which of Sweden’s 290 municipalities reported data to the Social Service Register. We calculated proportions of the population (restricted to ages 80–89 years to enable comparison) that were reported to the Social Service Register in each municipality and presented the types and amount of care recorded in the register. Results: The proportion of municipalities reporting to the Social Service Register increased from 82% to 98% during the study period but several municipalities reported fragmentarily and inconsistently, particularly during earlier years. Among municipalities reporting to the Social Service Register, 9% of the population aged 80–89 years resided in care homes and 19% received home care, but the registered amount and types of care varied substantially between municipalities and over time. Conclusions: The Swedish Social Service Register provides valuable data for research on aging and elder care utilisation, but data should be selected and vetted carefully, especially for earlier years. The amount and types of care may not always be comparable between geographical regions and different time periods. In recent years, however, the coverage of the Social Service Register is good.

The association of loneliness with health and social care utilisation in older adults in the general population: A systematic review

Background and Objectives Loneliness is proposed to be linked with increased service use. This review examined the association of loneliness and health and social care utilisation (HSCU) in older adults from the general population. Research Design and Methods Four databases were screened for studies that examined the association of loneliness (predictor) with HSCU (outcome) in older adults (defined as majority of sample 60 or older). Study quality was assessed with the NIH scale for observational cohorts and cross-sectional studies. Results We identified 32 studies, of which 9 prospective studies were evaluated as being good or good-fair quality. Two good-fair quality studies found loneliness at baseline was associated with subsequent admission to a residential care home. There was emerging evidence that loneliness was associated with emergency department use (n=1), and CVD-specific hospitalisation (n=1). Once adjusted for confounders the highest quality studies found no association of baseline loneliness with physician utilisation, outpatient service utilisation, skilled nursing facility use, and planned or unplanned hospital admissions. The remaining, studies were cross-sectional, or of fair to poor quality, and inadequate to reliably determine whether loneliness was associated with a subsequent change in HSCU. Discussion and implications There was heterogeneity in study design, measurement, and study quality. This generated an inconsistent evidence base where we cannot determine clear inferences about the relationship between loneliness and HSCU. Only one consistent finding was observed between two good-fair quality studies regarding care home admission. To determine clinical implications and make reliable inferences additional good quality longitudinal research is needed.

Health care utilisation following childhood acute lymphoblastic leukaemia: a population-based matched cohort study

ObjectivesSurvival among children diagnosed with acute lymphoblastic leukaemia (ALL) has increased considerably. However, morbidity in survivors constitutes a potential increasing burden not limited to secondary health care. Our objectives were to compare health care utilisation, including both primary and secondary health care, between childhood ALL survivors and matched references up to 15 years after curative treatment. Moreover, to increase knowledge on survivors’ health service seeking behaviour as time from treatment elapsed.Design and settingA Danish population-based matched cohort study linking multiple nationwide registries.Participants675 cases, diagnosed with childhood (1.0–17.9 years) ALL between 1994 and 2015, and 6750 matched references sampled randomly from the source population (matched on age, gender and geographical region).Primary outcome measuresRepeated consultations in general practice and hospital (outpatient and inpatient) estimated as yearly rates from 2.5 years after diagnosis and onwards. We compared cases and references with yearly incidence rate ratios (IRRs) from negative binomial regression models.ResultsSurvivors of childhood ALL had a mean number of yearly daytime contacts in general practice of 4.75 (95% CI 4.41 to 5.11) the first year, corresponding to an IRR of 1.85 (95% CI 1.71 to 2.00); decreasing to 1.16 (1.01 to 1.34) after 15 years, and without significant impact of gender (p=0.894) or age (p=0.399). For hospital contacts, ALL survivors had a mean number of yearly contacts of 14.21 (13.38–15.08) the first year, corresponding to an IRR of 31.50 (28.29–35.07); decreasing to 2.42 (1.59–3.68) after 15 years. No differences were found across calendar time.ConclusionsALL survivors used significantly more health care services across sectors than the reference population. Decreasing use over 15 years illustrated the dynamics of health care needs; this knowledge may inform the future organisation of integrated follow-up programmes.Trial registration numberNCT03985826.

SNAP participation and the health and health care utilisation of low-income adults and children

Objective: This article examined whether participation in the Supplemental Nutrition Assistance Program (SNAP) produced changes to adult and child health and health care utilisation during a period of economic recession. Design: Instrumental variables analysis relying on variation in state SNAP policies to isolate exogenous variation in household SNAP participation. Setting: Nationally representative data on child and adult health from the 2008 to 2013 National Health Interview Survey. Participants: Participants were 92 237 adults and 45 469 children who were either eligible for SNAP based on household income and state eligibility rules or were low income but not eligible for SNAP benefits. Results: For adults, SNAP participation increased the probability of reporting very good or excellent health, and for both adults and children, reduced needing but having to go without dental care or eyeglasses. The size of these benefits was especially pronounced for children. However, SNAP participation increased the probability of needing but not being able to afford prescription medicine, and increased psychological distress for adults and behavioural problems for children under age 10. Conclusions: SNAP’s benefits for adult health and improved access to dental and vision care for adults and children suggest benefits from the program’s expansions during the current COVID-induced crisis. Predicted negative effects of SNAP participation suggest the need for attention to program and benefit structure to avoid harm and the need for continued research to explore the causal effects of program participation.

1448Intensive care utilisation in New Zealand 2010 to 2020

Background Many countries are assessing their capacity of intensive care (IC) after COVID-19 outbreak due to massively increase in the utilisation. This work analysed the utilisation of IC in New Zealand (NZ) between 2010 and 2020, as a base to predict and plan the health service in the future. Methods Inpatient events from NZ national data collection and datasets from the Australian and New Zealand Intensive Care Society were matched to generate a relatively comprehensive IC dataset for patients cared in NZ. Results Over the period, around 182,000 IC inpatient events with associated 12.1 million IC hours were identified. For NZ patients, age-standardised rate was 328 events or 905 IC bed days per 100,000 population. The age-standardised rates were significantly higher in Maori and Pacific, and significantly lower in Asian population. The absolute IC events and IC hours significantly increased over the period, with a slope of 390 IC events or 29,000 IC hours per year. Significant increase in IC hours over the period were found in the diagnostic categories of injuries, cardiovascular diseases, neurological conditions and lower respiratory infections; or patients cared by health specialties of cardiothoracic surgery, general surgery, orthopaedic surgery and respiratory medicine. Conclusions The IC utilisation are different in population subgroups. Trends and volumes of IC utilisation in different clinical diagnoses and health specialties were quantified. Key messages With population projection, these results provide evidence to predict IC capacity demand and to design IC services (e.g. health specialties, IC beds and investment needed) in the future.