Too much? Mortality and health service utilisation among Danish children 1999-2016: A register-based study

Objectives To describe the temporal development of mortality and health service utilisation defined as in- and outpatient hospital contacts, contacts with general practitioner and specialists, and prescribed dispensed medication among Danish children 0–5 years of age from 1999 to 2016. Design Register-based descriptive study. Participants All children born in Denmark in the period 1994–2016 followed until 5 years of age. Main outcome measures Annual incidence rates of mortality and health service utilisation outcomes, and incidence rate ratios compared to the reference calendar year 1999. The new measure of post-discharge mortality is presented. Results Post-discharge mortality decreased from 1999 to 2016, IRR 2016 = 0.49 (95% CI: 0.36 to 0.66). Total contacts did not change much over time, IRR 2016 = 1.02 (1.02 to 1.03), but increased among neonates, IRR 2016 = 3.69 (3.63 to 3.75), and decreased among children with chronic disease IRR 2016 = 0.94 (0.93 to 0.94). In- and out-patient hospitalisations increased, IRR 2016 = 1.26 (1.24–1.27) resp. IRR 2016 = 1.62 (1.60–1.63), contacts with medical specialists increased, IRR 2016 = 1.43 (1.42 to 1.43), whilst contacts with general practitioner decreased, IRR 2016 = 0.91 (0.91 to 0.91). Medication use decreased, IRR 2016 = 0.82 (0.82 to 0.82). Conclusions Our measure of post-discharge mortality was halved during the study period indicating improved health. Overall health service utilisation did not change much, but the type of utilisation changed, and the development over time differed between subgroups defined by age and chronic disease status. Our findings call for considerations about the benefit of increased specialisation and increased use of health services among ‘healthy’ children not suffering from chronic disease.