Social Insurance Institution Research Articles

Odwołanie komornika z zajmowanego stanowiska – praktyczne aspekty

The article presents the broad subject matter relating to the long-term replacement of a bailiff due to his dismissal after he becomes 65 years old. First of all, general premises have been presented with regard to appointing a long-term replacement. Next, the author focused on the issue related to the dismissal of a bailiff under art. 19(1)(2) of the Act on bailiff costs. The regulation, even though it has been in force for three years already, still raises numerous controversies and has become a reason for discussions, both in literature and judicature. As a result of such changes, numerous bailiffs have appealed against decisions of the Minister of Justice with regard to their dismissal from office due to turning 65. Considerable doubts have arisen in this regard, both based on the regulations of the Constitution of the Republic of Poland and the Act on old-age pensions and pensions paid by the Social Insurance Institution (ZUS). Such problems have been discussed in the article, due to the lack of accurate regulations. Keywords: long-term replacement, dismissing a bailiff, retirement age

Obesity, Fruit and Vegetable Intake, and Physical Activity Patterns in Austrian Farmers Compared to the General Population.

Low fruit and vegetable (F&V) intake, sedentary behavior, excessive alcohol consumption, and smoking are risk factors for the development of non-communicable diseases. This study describes the patterns and factors of nutrition (F&V and alcohol intake), physical activity (PA), obesity, and other chronic diseases of 10,053 adult farmers (52.7% female) in Austria, based on the cross-sectional survey from the Austrian Social Insurance Institution for the Self-Employed and compared with the results of the general Austrian population from 2019 (n = 14,606; 53.7% female). Compared to the general Austrian population, farmers showed a higher prevalence of overweight and obesity (42.8% vs. 36.5%; 18.8% vs. 17.1%), as well as hypertension, hypercholesterolemia, and diabetes mellitus. Additionally, farmers ate less F&V (0 servings/day 39.7% vs. 14.0%; 1–4 servings/day 55.5% vs. 80.8%) and only 4.8% vs. 5.1% (p < 0.001) fulfilled the F&V recommendations. Lower participation in endurance training (38.3% vs. 52.1%) was found, whereas farmers did more strength training (64.1% vs. 27.6%). Those who failed to fulfill the PA recommendations reported worse health status (OR: 3.14; 95%-CI: 2.08–4.76) and a higher chance for obesity (OR: 1.68; 95%-CI: 1.38–2.05). Since obesity rates among farmers are high and recommendations have rarely been met, every opportunity should be taken to promote healthy eating and adequate PA.

The Effects of Social Network and Institutional Embeddedness on Household Consumption: Evidence from China Household Finance Survey

Consumer behavior is embedded in a certain social structure and social networks, and the scale and density of household social networks will be likely to affect consumption expenditure. To explore the impact of social networks and institutional embeddedness on household consumption, this study constructs a model of consumption influencing factors, and devises an empirical study using the data of China Household Finance Survey (CHFS). The results show some innovation. (1) The impact of household social networks on total household consumption is significant. A 1% increase in social networks spending boosts household consumption spending by 0.364%. (2) The institutional embeddedness will affect household consumption. Every 1% increase of social security account balance (the proxy variable of institutional embeddedness) can boost household consumption by 0.196%. This proves that the social insurance institution can enhance consumer confidence and promote current consumption growth. (3) The results of the robustness test confirmed that even after replacing the dependent variable with “the proportion of developmental consumption in total household consumption,” the influence of social networks and institutional embeddedness on consumption is still significant. Using the variable “communication expenses” instead of “gift income and expenditure” as the proxy variable of social networks, the estimation result is still robust. (4) Social networks have a significant influence on all types of household consumption except medical care consumption, but the degree of influence is different. Further discussion revealed that the estimation results are different for different regions in China, but the coefficients of core independent variables are not significantly different. This conclusion is different from people’s intuition, which holds that people in regions with low economic development rely more on social communication and spend more on social communication to maintain a certain social status. The conclusion of this paper is of great significance for formulating policies and institutions affecting residents’ consumption.

Changes in Visual Impairment due to Diabetic Retinopathy During 1980-2019 Based on Nationwide Register Data.

OBJECTIVETo evaluate changes in the incidence, prevalence, severity, and onset age of visual impairment (VI) due to diabetic retinopathy (DR) and compare these trends in the screening and treatment of diabetes during 40 years based on Finnish national register data.RESEARCH DESIGN AND METHODSWe included people with VI with nonproliferative DR (NPDR; n = 2,490, 73% women) or proliferative DR (PDR; n = 2,026, 53% women) as the main diagnosis for VI during 1980–2019 in the Finnish Register of Visual Impairment. The number of patients with treated diabetes during 1986–2019 was obtained from the Social Insurance Institution of Finland registers based on reimbursed medication data.RESULTSThe annual incidence of reported VI due to DR has decreased since it peaked in the 1990s: regarding NPDR, it decreased from 102.3 to 5.5 per 100,000 patients with treated diabetes between the 1990s and 2010s; regarding PDR, the respective change was from 39.9 to 7.4. The incidence of patients with diabetes treated for DR increased during this period. Annual prevalence of reported VI and differences between sexes steadily decreased in the 2000s and 2010s. The severity of reported VI has decreased, and the age at the onset of reported VI increased during the 40 years.CONCLUSIONSPrevalence and incidence of VI due to DR have dramatically decreased and shifted to older age during the 40 years despite the increasing prevalence of diabetes. These positive trends highlight the successful development and effectiveness of screening and therapies for diabetes and DR.

THE EXEMPTION FROM THE OBLIGATION TO PAY CONTRIBUTIONS RESULTS FROM THE PROVISIONS OF ART. 31 OF ZO. 8, 10 AND 12 OF THE COVID-19 ACT

The SARS-CoV-2 epidemic had a huge impact on the functioning of every sphere of public life. The introduction of restrictions or even bans on conducting business activity in many industries had an obvious impact on the situation of entrepreneurs. The state has taken specific measures to minimize the negative impact of the introduced restrictions and bans, and those addressed to entrepreneurs deserve special attention. One of its forms is the possibility for entrepreneurs to apply for the reduction of their public-law burdens or for an exemption from bearing them. Such a benefit is granted to entrepreneurs under the so-called Anti-crisis Shield related to the pandemic state introduced in the country, the possibility of submitting to the Social Insurance Institution (hereinafter: ZUS) an application for exemption from paying contributions due to payers in specific industries.

Sickness absence in 2019-2020 and the activities of the Social Insurance Institution (ZUS) to prevent incapacity for work

Sickness absence is an important measure of the current situation on the labor market and a source of information on the health condition of the working part of the society. It is also a phenomenon that directly affects the economy. Monitoring the size and causes of sickness absence enables the adjustment of the social and health policy in the country. In Poland, sickness absence is most often analyzed in the context of people receiving sickness allowance - a benefit from the social security system granted to insured persons in the event of incapacity to work due to illness. In 2020, there were noticed over 256 million days of sickness absence, of which the largest part (45 million days) were due to conditions related to pregnancy, childbirth and puerperium. In turn, COVID-19 was responsible for almost 5 million days of sickness absence, of which 179 thousand days is the period of hospitalizations.&#x0D; In order to prevent permanent incapacity to work, the Social Insurance Institution (ZUS) runs a program of comprehensive therapeutic rehabilitation for insured persons with: diseases of motor organs (also after accidents), cardiovascular and respiratory diseases, psychosomatic diseases, oncological diseases after treatment of breast cancer and voice organ' cancer.

Impact of Oral Anticoagulation and Adenosine Diphosphate Inhibitor Therapies on Short-term Outcome of Traumatic Brain Injury.

Usage of oral anticoagulants (OACs) or adenosine diphosphate inhibitors (ADPi) is known to increase the risk of bleeding. We aimed to investigate the impact of OAC and ADPi therapies on short-term outcomes after traumatic brain injury (TBI). All adult patients hospitalized for TBI in Finland during 2005-2018 were retrospectively studied using a combination of national registries. Usage of pharmacy-purchased OACs and ADPi at the time of TBI was analyzed with the pill-counting method (Social Insurance Institution of Finland). The primary outcome was 30-day case-fatality (Finnish Cause of Death Registry). The secondary outcomes were acute neurosurgical operation (ANO) and admission duration (Finnish Care Register for Health Care). Baseline characteristics were adjusted with multivariable regression, including age, sex, comorbidities, skull or facial fracture, OAC/ADPi treatment, initial admission location, and the year of TBI admission. The study population included 57,056 persons (mean age 66 years) of whom 0.9% used direct OACs (DOACs), 7.1% vitamin K antagonists (VKA), and 2.3% ADPi. Patients with VKAs had higher case-fatality than patients without OAC (15.4% vs 7.1%; adjusted hazard ratio [aHR] 1.35, CI 1.23-1.48; p < 0.0001). Case-fatality was lower with DOACs (8.4%) than with VKAs (aHR 0.62, CI 0.44-0.87; p = 0.005) and was not different from patients without OACs (aHR 0.93, CI 0.69-1.26; p = 0.634). VKA usage was associated with a higher neurosurgical operation rate compared with non-OAC patients (9.1% vs 8.3%; adjusted odds ratio 1.33, CI 1.17-1.52; p < 0.0001). There was no difference in operation rate between DOAC and VKA. ADPi was not associated with case-fatality or operation rate in the adjusted analyses. VKAs and DOACs were not associated with longer admission length compared with the non-OAC group, whereas the admissions were longer in the ADPi group compared with the non-ADPi group. Preinjury use of VKA is associated with increases in short-term mortality and in need for ANOs after TBI. DOACs are associated with lower fatality than VKAs after TBI. ADPi were not independently associated with the outcomes studied. These results point to relative safety of DOACs or ADPi in patients at risk of head trauma and encourage to choose DOACs when oral anticoagulation is required. This study provides Class II evidence that among adults with TBI, mortality was significantly increased in those using VKAs but not in those using DOACs or ADPi.

Joint association of socioeconomic circumstances and minor mental health problems with antidepressant medication.

BackgroundDisadvantageous socioeconomic circumstances and minor mental health problems have both been associated with mental disorders, such as depression, but their joint contribution remains unknown.MethodsThe Helsinki Health Study baseline survey (2000–02) of 40- to 60-year-old employees was linked with antidepressant medication data from registers of the Social Insurance Institution of Finland. The analyses were made using logistic regression with first prescribed antidepressant medication purchase during a 10-year follow-up as the outcome. Minor mental health problems were measured by the emotional well-being scale of the RAND-36. Odds ratios were calculated for joint association of the lowest quartile of the emotional well-being scale of the RAND-36 and socioeconomic circumstances. Childhood (parental education and childhood economic difficulties), conventional (education, occupational class and income) and material (housing tenure and current economic difficulties) socioeconomic circumstances were examined. This study included 5450 participants.ResultsMinor mental health problems dominated the joint associations. Minor mental health problems were associated with antidepressant medication irrespective of socioeconomic circumstances whereas only low income, current economic difficulties and living in rented housing showed an association without minor mental health problems at baseline. Marital status, working conditions and BMI and health behaviours had only minimal contributions to the associations.ConclusionsMinor mental health problems were consistently and strongly associated with antidepressant medication and dominated the joint associations with socioeconomic circumstances. Paying attention to minor mental health problems might help prevent mental disorders such as depression.

Impact of the COVID-19 pandemic on employment and social benefit receipt in Finland

AbstractThe COVID-19 crisis tested welfare states’ resilience in protecting citizens against sudden health-related and economic shocks. However, the crisis’ effects and responses to it vary substantially across countries. Using administrative registers of the Social Insurance Institution of Finland, we evaluate the impact of the COVID-19 crisis on various socio-economic groups by examining the receipt of social benefits and length of benefit spells. Furthermore, we analyse the duration of unemployment and social assistance spells that started during the outbreak of the COVID-19 pandemic and the probabilities of receiving social assistance among different socio-economic groups during the crisis. The results of our analysis show that in 2020, the receipt of unemployment and social assistance benefits was highest among young people and particularly among women. However, extending the analysis to 2021 we found that unemployment spells were shorter among young people than among older age groups. Thus, while the youngest age groups were hardest hit by the crisis in terms of the increase in the number of recipients, they seem to have recovered from it faster than the older age groups. Our findings indicate that the Finnish social security system succeeded fairly well in mitigating the negative impacts of the crisis for vulnerable groups and those who faced job loss since small adjustments to the benefits maintained the income of these groups.

Gastrointestinal bleeding preceding new-onset atrial fibrillation - results from the nationwide FinACAF study

Abstract Funding Acknowledgements Type of funding sources: Public hospital(s). Main funding source(s): Helsinki and Uusimaa Hospital District Funding The Finnish Foundation of Cardiovascular Research Introduction Initiation of oral anticoagulation (OAC) in case of a new-onset atrial fibrillation (AF) requires assessment of bleeding history. Gastrointestinal (GI) bleedings are among the most common bleeding events. Purpose We aimed to assess clinical characteristics and initiation of OAC in patients with new-onset AF and a history of previous GI bleeding. Methods The Finnish AntiCoagulation in Atrial Fibrillation (FinACAF) study is a nationwide study among AF patients conducted as a retrospective register-based linkage study combining data from several Finnish health care registers. The study population consists of all patients diagnosed with AF between the years 2010-2018 and with laboratory data available. Patients were identified from nationwide primary care and reimbursement registries and hospitalization records. OAC purchases at 90 days from cohort entry were obtained from the National Prescription Register upheld by the Social Insurance Institution of Finland. Results 134 242 patients from the initial FinACAF cohort were included in this substudy. Of these, 6543 (4.9%) patients had a history of GI bleeding. Those with GI bleeding were more often male (52.6%), older (mean age 76.6 ± 11.4 vs 72.4 ± 13.1 years), and had more comorbidities. They also had lower blood hemoglobin (mean 124.9 ± 21.3 vs 135.8 ± 18.4 g/l) and higher serum creatinine (mean 99.7 ± 75.8 vs 87.5 ± 52.7 µmol/l) levels than patiens without preceding GI bleeding. Furthermore, initiation of OAC medication was less frequent in the GI bleeding group (46.9% vs 58.6%). Patient characteristics of the study population including age, sex, comorbidities, OAC medication and laboratory findings are shown in Figures 1 and 2. Conclusions Patients with AF and preceding GI bleeding are vulnerable to rebleeding events. This may affect decision-making of clinicians, leading to more infrequent initiation of OAC medications.

State Aid for SMEs During the Pandemic in Poland

Theoretical background: The global SARS-CoV-2 virus pandemic is affecting everyone, either directly or indirectly. To mitigate the negative economic outcome of the restrictions introduced in order to limit the spread of the virus, the majority of countries have introduced a number of solutions enabling enterprises to survive and maintain employment. Poland has also implemented a whole range of instruments aimed at supporting enterprises and people who have lost their livelihood. Purpose of the article: The aim of the paper is to review selected support instruments for enterprises from the SME group and to determine the degree of their use. Research was carried out to verify the hypothesis that these instruments played a significant role in the survival of enterprises, however, their lump sum nature meant that the aid was not adequate to the needs at a micro-economic level. Research methods: Six instruments were subjected to evaluation, i.e. the standstill benefit, exemption from the Social Insurance Institution fees, low-interest loans from the Labour Fund for micro-enterprises, partial financing of business and partial financing of salary costs, as well as a financial subsidy used by 157 SMEs up to November 30, 2020. During the first step, an analysis was conducted regarding the number of instruments that were used by enterprises, in particular, subgroups. In the second step, using a correlation analysis, the amount of aid obtained in 2020 from 6 analyzed instruments under the shields launched in the first half of the year, used by entrepreneurs by the end of 2020, was compared with the revenues and pre-tax results of enterprises from a given sample. Main findings: State aid was necessary to maintain jobs and satisfactory financial conditions of companies. However, the aid introduced in the first months of the pandemic did not match the real needs of enterprises. The conditions of availability regarding individual instruments made it possible to use them by entities that did not, in reality, require state aid. Nonetheless, from the fall of 2020 (during subsequent waves of the pandemic), the aid was targeted at specific industries, and its use required more stringent conditions to be met.

Relative wage premium as a result of residence relocation of university graduates

Changing the place of residence after obtaining a university degree is one of the components of a broader issue of internal migration. The migration of people with higher education is a popular object of research, but until recently there were no data on migration immediately following graduation. The aim of the article is to demonstrate the occurrence of a relative wage premium related to this migration within a year after graduating, i.e. an increase in earnings resulting from moving to a different city. The study focused on groups of people who obtained their diploma in 2018 in the most popular fields of study within economics and technical sciences. An appropriate aggregation of data was made from the Polish Graduate Tracking System using the Social Insurance Institution (ZUS) data. It has been shown that the values of the relative earnings index for the analysed fields of study determined in this system were always higher for people who after obtaining their diploma in 2018 lived in 2019 in a voivodship other than their place of study, compared to those who remained in the powiat of their alma mater. This indicates the economic determinants of migration, i.e. the wage premium, related to the relocation of residence after obtaining a diploma.

One-year healthcare costs of patients with spontaneous intracerebral hemorrhage treated in the intensive care unit.

Background:Spontaneous intracerebral hemorrhage (ICH) entails significant mortality and morbidity. Severely ill ICH patients are treated in intensive care units (ICUs), but data on 1-year healthcare costs and patient care cost-effectiveness are lacking.Methods:Retrospective multi-center study of 959 adult patients treated for spontaneous ICH from 2003 to 2013. The primary outcomes were 12-month mortality or permanent disability, defined as being granted a permanent disability allowance or pension by the Social Insurance Institution by 2016. Total healthcare costs were hospital, rehabilitation, and social security costs within 12 months. A multivariable linear regression of log transformed cost data, adjusting for case mix, was used to assess independent factors associated with costs.Results:Twelve-month mortality was 45% and 51% of the survivors were disabled at the end of follow-up. The mean 12-month total cost was €49,754, of which rehabilitation, tertiary hospital and social security costs accounted for 45%, 39%, and 16%, respectively. The highest effective cost per independent survivor (ECPIS) was noted among patients aged >70 years with brainstem ICHs, low Glasgow Coma Scale (GCS) scores, larger hematoma volumes, intraventricular hemorrhages, and ICH scores of 3. In multivariable analysis, age, GCS score, and severity of illness were associated independently with 1-year healthcare costs.Conclusions:Costs associated with ICHs vary between patient groups, and the ECPIS appears highest among patients older than 70 years and those with brainstem ICHs and higher ICH scores. One-third of financial resources were used for patients with favorable outcomes. Further detailed cost-analysis studies for patients with an ICH are required.

Is early exposure to cannabis associated with bipolar disorder? Results from a Finnish birth cohort study.

Background and aimsThere are few longitudinal studies assessing the association of cannabis use and subsequent onset of bipolar disorder. We aimed to measure the association between early cannabis exposure and subsequent bipolar disorder.Design, Setting and ParticipantsObservational study linking a sample from the northern Finland birth cohort 1986 (n = 6325) to nation‐wide register data to examine the association of life‐time cannabis exposure at age 15/16 years and subsequent bipolar disorder until age 33 (until the end of 2018); 6325 individuals (48.8% males) were included in the analysis.MeasurementsCannabis exposure was measured via self‐report. Bipolar disorder was measured via bipolar disorder‐related diagnostic codes (ICD‐10: F30.xx, F31.xx) collected from the Care Register for Health Care 2001–18, the Register of Primary Health Care Visits 2011–18, the medication reimbursement register of the Social Insurance Institution of Finland 2001–05 and the disability pensions of the Finnish Center for Pensions 2001–16. Potential confounders included demographic characteristics, parental psychiatric disorders, emotional and behavioral problems and other substance use.FindingsThree hundred and fifty‐two adolescents (5.6%) reported any cannabis use until the age of 15–16 years. Of the whole sample, 66 (1.0%) were diagnosed with bipolar disorder. Adolescent cannabis use was associated with bipolar disorder [hazard ratio (HR) = 3.46; 95% confidence interval (CI) = 1.81–6.61]. This association remained statistically significant after adjusting for sex, family structure and parental psychiatric disorders (HR = 3.00; 95% CI = 1.47–6.13) and after further adjusting for adolescent emotional and behavioral problems (HR = 2.34; 95% CI = 1.11–4.94). Further adjustments for frequent alcohol intoxications, daily smoking and lifetime illicit drug use attenuated the associations to statistically non‐significant.ConclusionsIn Finland, the positive association between early cannabis exposure and subsequent development of bipolar disorder appears to be confounded by other substance use.

Long-Term Use of Short-Acting β2-Agonists in Patients With Adult-Onset Asthma

Short-term studies have associated high use of short-acting β2-agonists (SABA) with increased risk of exacerbations, emergency visits, and asthma-related costs. However, no studies exist on long-term SABA use, and previous studies on the topic have not included information about adherence to inhaled corticosteroids (ICS) nor disease control, both affecting the need of SABA. To evaluate the clinical characteristics of SABA and ICS usage in newly diagnosed adult-onset asthma patients during a 12-year follow-up period. In the Seinäjoki Adult Asthma Study, 203 patients with adult-onset asthma were followed for 12 years. Information on dispensed SABA and ICS during the follow-up was obtained from the Finnish Social Insurance Institution. High SABA use was defined as ≥36 canisters in 12 years, corresponding to an average of ≥3 dispensed canisters/y. Patients were dispensed median 6 (interquartile range: 3-16) SABA canisters and 48 (18-67) ICS canisters over 12 years, corresponding to 2 (1-4) and 11 (5-16) puffs/week, respectively. Only 10% of the patients were classified as high SABA users during this period. Obesity (body mass index ≥30) and high Airways Questionnaire 20 symptom scores at baseline predicted high long-term SABA use (incidence rate ratio: 1.53 [1.01-2.30] and 1.04 [1.00-1.08], respectively). High SABA users had higher ICS adherence, higher blood neutrophil counts, more comorbidities, and used more oral corticosteroid and antibiotic courses versus low SABA users. High SABA use was infrequent in patients with confirmed adult-onset asthma. However, as high SABA use is associated with more severe asthma, these patients should be recognized in clinical practice.

Additional Forms of Retirement Savings under the Third Pillar of the Polish Retirement Protection System

The purpose of the article is to present the additional forms of retirement savings under the third pillar of the Polish retirement protection system as well as in the broader context of the national pension insurance system, taking into consideration legal regulations concerning pension benefits paid by the Polish Social Insurance Institution (ZUS). The author synthetically discusses various schemes operating in the third pension pillar (EPS, IRA, IRPA and ECP), and analyses the adequacy of the adopted solutions in the light of the basic aim of this system which is to complement benefits paid under the national pension system. In addition, benefits paid out to the participants to the third pillar schemes are discussed in detail in the context of the overall objective of the third pillar.

Use of psychotropic medication in incident juvenile idiopathic arthritis patients from 2000 to 2014: a case-control cohort study.

To explore the use of psychotropic medications in patients with juvenile idiopathic arthritis (JIA) compared to population controls. Using register data from the Social Insurance Institution of Finland and the National Population Registry, we collected all incident JIA patients with index dates from 2000 to 2014 (n=4,180) and three population comparators for each case (n=12,512). For these individuals, we obtained information on their psychotropic medication from the registry on prescriptions, which includes all purchases of prescription medicines in pharmacies. The study populationwas followed from their index dates until 31 December 2015. The data were analysed using generalised linear models. The mean age (SD) of the JIA patients at disease onset was 8.3 (4.8) years, and 14.8 (6.4) years at the end of the follow-up period. During the follow-up years, 566 (13%) of the JIA patients had purchased some psychotropic drug from a pharmacy, whereas the number in the control group was 1,294 (10%; p<0.001). Antidepressants were the most purchased drugs in both groups. Further analysis by gender showed that females with JIA used antidepressants more often than males with JIA. The use of psychotropic medication, particularly antidepressants, was more common in patients with JIA compared to comparators in the general population. This reflects the presence of clinically important mental health problems in JIA patients and the need for multiprofessional collaboration in patient care.

COVID-19 and Mortality, Depression, and Suicide in the Polish Population.

AimThe study was aimed at assessing the mortality of the population, the occurrence of the phenomenon of depression and suicide before and during the COVID-19 pandemic.MethodsData on total mortality in Poland in 2017–2021 came from the report of the Ministry of Health. Data on the number of sick leave due to mental disorders were taken from the report of the ZUS (Social Insurance Institution in Poland). Data on the number of suicides came from police statistics.ResultsIncrease in the number of deaths in Poland in 2021 compared to the 2017–2019 average – 26.86%. In 2018–2020, the greatest number of fatal suicides was recorded in the age group – 60–64 years (in 2018 N = 565; 10.90%; in 2020 N = 524; 10.15%).ConclusionsIn the years 2020-2021, an increase in mortality was observed in Poland compared to the previous years. Moreover, in 2020 there was an increase in sickness absence due to ICD-10 F.32 and an increase in the number of suicide attempts.

Changes in the societal burden caused by sleep apnoea in Finland from 1996 to 2018: A national registry study.

SummaryBackgroundIn the current century, sleep apnoea has become a significant public health problem due to the obesity epidemic. To increase awareness, improve diagnostics, and improve treatment, Finland implemented a national sleep apnoea programme from 2002 to 2010. Here, we present changes in the societal burden caused by sleep apnoea from 1996 to 2018.MethodsNational register data were collected from the Care Register for Health Care, Statistics Finland, the Social Insurance Institution of Finland, and the Finnish Centre for Pensions. Disease prevalence, use of healthcare and social services, and societal costs were estimated.FindingsThe number of sleep apnoea patients increased in secondary care from 8 600 in 1996 to 61 000 in 2018. There was a continuous increase in outpatient visits in secondary care from 9 700 in 1996 to 122 000 in 2018 (1 160%) and in primary care from 10 000 in 2015 to 29 000 in 2018 (190%). Accordingly, the cumulative annual number of days off work for sleep apnoea increased from 1 100 to 46 000. However, disability pensions for sleep apnoea decreased from 820 to 550 (33%) during the observation period. Societal costs per patient decreased over 50% during the observation period (€2 800 to €1 200).InterpretationThe number of sleep apnoea patients in Finland increased remarkably during the observation period. To control this burden, diagnostic methods and treatment were revised and follow up was reorganised. Consequently, there was a significant decrease in societal costs per patient. The decrease in disability pensions suggests earlier diagnosis and improved treatment. The national sleep apnoea programme was one of the initiators for these improved outcomes.FundingThe Finnish Institute for Health and Welfare and the Hospital District of Helsinki and Uusimaa (HUH), Helsinki, Finland.

Healthcare costs and mortality associated with serious fluoroquinolone-related adverse reactions.

The aim of this study was to estimate healthcare costs and mortality associated with serious fluoroquinolone‐related adverse reactions in Finland from 2008 to 2019. Serious adverse reaction types were identified from the Finnish Pharmaceutical Insurance Pool’s pharmaceutical injury claims and the Finnish Medicines Agency’s Adverse Reaction Register. A decision tree model was built to predict costs and mortality associated with serious adverse drug reactions (ADR). Severe clostridioides difficile infections, severe cutaneous adverse reactions, tendon ruptures, aortic ruptures, and liver injuries were included as serious adverse drug reactions in the model. Direct healthcare costs of a serious ADR were based on the number of reimbursed fluoroquinolone prescriptions from the Social Insurance Institution of Finland’s database. Sensitivity analyses were conducted to address parameter uncertainty. A total of 1 831 537 fluoroquinolone prescriptions were filled between 2008 and 2019 in Finland, with prescription numbers declining 40% in recent years. Serious ADRs associated with fluoroquinolones lead to estimated direct healthcare costs of 501 938 402 €, including 11 405 ADRs and 3,884 deaths between 2008 and 2019. The average mortality risk associated with the use of fluoroquinolones was 0.21%. Severe clostridioides difficile infections were the most frequent, fatal, and costly serious ADRs associated with the use of fluoroquinolones. Although fluoroquinolones continue to be generally well‐tolerated antimicrobials, serious adverse reactions cause long‐term impairment to patients and high healthcare costs. Therefore, the risks and benefits should be weighed carefully in antibiotic prescription policies, as well as with individual patients.