Social Insurance Institution Research Articles

Incidence and familial risk of premature ovarian insufficiency in the Finnish female population.

STUDY QUESTIONWhat is the incidence of premature ovarian insufficiency (POI), has the incidence of POI changed over time, and what is the risk of POI among relatives of POI women?SUMMARY ANSWERThe incidence of POI increased among females aged 15–19 years from 2007 onwards and decreased in older age groups, and among relatives of women with POI the risk of POI is significantly increased.WHAT IS KNOWN ALREADYSo far, there has been no good quality, nationwide studies of the incidence of POI. Early menopause has been associated with the elevated risk of early menopause among relatives, but the knowledge of the familial risk of POI is scarce. Lower socioeconomic status has been associated with lower age at natural menopause.STUDY DESIGN, SIZE, DURATIONPopulation-based study with 5011 women diagnosed with POI in 1988–2017. The data were collected from national registries and covers POI subjects in entire Finland.PARTICIPANTS/MATERIALS, SETTING, METHODSWomen with hormone replacement therapy reimbursement for POI were identified from Social Insurance Institution (SII). We calculated POI incidence in different age groups and studied the changes in the incidence rate over time in 5-year segments. Four population-based controls were selected from the Digital and Population Data Services Agency (DVV) for each POI woman. Family members of the POI cases and controls were identified from the DVV and linked to SII reimbursement data to identify POI diagnoses among them. The familial risk of POI was estimated with a logistical regression model.MAIN RESULTS AND THE ROLE OF CHANCEThe incidence was highest in the 35–39 age group, ranging from 73.8/100 000 women-years in 1993–1997 to 39.9/100 000 women-years in 2013–2017. From 2007, the incidence among 15- to 19-year-olds rose from 7.0 to 10.0/100 000 women-years in 2015–2017. Cumulative incidence of POI for women under 40 years in 1988–2017 was 478/100 000 women. The relative risk of POI among relatives of women with POI was 4.6 (95% CI 3.3–6.5) compared to relatives of women without POI. POI women tended to have slightly lower socioeconomic status and level of education compared to controls.LIMITATIONS, REASONS FOR CAUTIONFor some women with POI, diagnosis or reimbursement may be lacking. However, we presume that these women represent a minority due to the nature of the disease and the economic benefits of reimbursement. Some changes in the incidence of POI can reflect changes in clinical practice and changing treatments and reimbursement criteria.WIDER IMPLICATIONS OF THE FINDINGSThe risk of developing POI is significantly higher in women who have first-degree relatives diagnosed with POI. Raising awareness of the increased risk might lead to earlier diagnosis and initiation of hormonal replacement therapy, possibly preventing adverse effects of low oestrogen levels, such as osteoporosis.STUDY FUNDING/COMPETING INTEREST(S)This work was financially supported by the Oulu University Hospital. H.S. received a grant from Finnish Menopause Society. S.M.S. received a grant from the Finnish Menopause Society, the Finnish Medical Foundation and the Juho Vainio Foundation. The authors do not have any competing interests to declare.TRIAL REGISTRATION NUMBERN/A.

Administrative data as a source of information about employed persons

The pace of changes taking place in the contemporary world creates demand for current data at the lowest possible level of territorial aggregation, enabling the assessment of the impact of these changes on local labour markets. Data resources gathered in registers and administrative systems directly or indirectly related to employment seem to provide an opportunity to satisfy these new expectations. However, to be able to use administrative resources for statistical purposes, it is necessary to make allowances for the fact that the administrators of registers and administrative systems collect data to satisfy their own needs and that official statistics reuses them. The aim of the article is to show the analytical opportunities which administrative data sources provide and to demonstrate that they can complement or even replace traditional methods of collecting data on employed persons. The experimental adaptation of data from these sources for statistical purposes proves that, for example, data on employed persons, calculated on the basis of the resources of the Social Insurance Institution (ZUS) and the Agricultural Social Insurance Fund (KRUS), correspond almost fully in terms of definitions with data collected by official statistics. The readiness to come to terms with slight methodological differences related to the count of employed persons in agriculture or persons employed for the purpose of vocational training or agents will make it possible to provide users with this important labour market statistics faster, more frequently, and in aggregations different than those recently offered by official statistics, while limiting or even eliminating many reporting obligations imposed on the national economy entities. This article describes official statistics’ current methods of researching employed persons and compares them with the experimental method of calculating the number of these persons on the basis of administrative data sources. Due to the fact that data calculated by means of the experimental method are characterised by a multitude of new information, we decided to present here only selected examples of their analyses and contribution to expanding the knowledge about employed persons in the Polish economy. We would also like to emphasise that data used for this purpose refer to all employed persons (in all entities, including the smallest ones with the maximum of nine employed persons). Other advantages of the administrative data sources are the monthly availability of data and the possibility of aggregating them down to gmina (the lowest local administrative unit) level.

Prevalent migraine as a predictor of incident hypertension.

BackgroundMigraine has been associated with several diseases. This population-based prospective Finnish postal survey Health and Social Support Study explored whether self-reported migraine predicted incident hypertension independently in a working-age population by utilizing two data sources: the baseline survey from the year 1998 in combination with the follow-up survey data from the years 2003 and 2012 with linkage to the national Social Insurance Institution registry data of the special reimbursement medication for hypertension from 1999 to 2013. The survey follow-up reached until the second follow-up in the year 2012. The register follow-up also included the year 2013.MethodsThe present population-based prospective cohort study, utilizing two different data sources, included 8593 respondents (22.7% response rate) who participated in 1998, 2003, and 2012 but who did not report hypertension at the baseline in 1998, and whose responses could be linked with the Social Insurance Institution registry data from the beginning of 1999 to the end of 2013. The multivariable logistic regression analysis was based on the combined two data sets.ResultsA significant association of self-reported migraine and incident hypertension (odds ratio 1.37; 95% confidence interval 1.20–1.57) prevailed in the multiple logistic regression analysis adjusted for central socio-demographic and health behaviour variables.ConclusionExtra attention should be paid to prevention and control of hypertension in working-age migraine patients.

DOP02 Increasing incidence of Inflammatory Bowel Disease in a high prevalence country: A nationwide study in Finland

Abstract Background The burden of inflammatory bowel disease (IBD) in health care is high and the incidence and prevalence rates of IBD in Finland are among the highest in the world. Our aim was to assess the actual incidence and the trends of IBD in Finland during 2000–2020 using nationwide registry-based data. We also estimated the nationwide prevalence of IBD in 2000 and 2020. Methods This study included patients to whom IBD reimbursement was newly attributed between January 1, 2000 and December 31, 2021. Data were retrieved from the Social Insurance Institution of Finland. Incidence and prevalence rates were calculated by dividing the number of annual new IBD cases by the size of the population at risk during each calendar year. Results A total of 42,498 new IBD cases were identified during years 2000–2020; 31,372 with ulcerative colitis (UC) and 11,126 with Crohn’s disease (CD).The crude annual incidence per 100,000 increases in CD from 7.5 to 13.4 (IRR 1.02, CI 1.019 - 1.025) and in UC from 20.4 to 34.7 (IRR 1.03, CI 1.023 - 1.027) (Fig. 1). The crude prevalence of IBD increases from 376 to 972 per 100,000 (PRR 1.05, CI 1.046–1.047).Men have significantly higher incidence than women in UC (IRR 1.26, CI 1.228–1.284). In contrast, there is no difference between genders among CD patients (IRR 0.98, CI 0.95–1.02). In UC, the peak incidence occurs in the age group 25–29 (Fig. 2), whereas in CD, the incidence is highest in slightly younger patients (Fig. 3). Figure 1. Incidence of ulcerative colitis and Crohn`s disease in Finland during 2000–2020 Figure 2. Annual incidence of UC by age groups during 2000–2020 Figure 3. Annual incidence of CD by age groups during 2000–2020 Conclusion During the first two decades of the 21st century, the incidence of UC and CD continues to increase in Finland, and almost one percent of the population has IBD.

Prescription medication use after congenital heart surgery.

Improvements in mortality after congenital heart surgery have necessitated a shift in focus to postoperative morbidity as an outcome measure. We examined late morbidity after congenital heart surgery based on prescription medication use. Between 1953 and 2009, 10,635 patients underwent congenital heart surgery at <15 years of age in Finland. We obtained 4 age-, sex-, birth-time, and hospital district-matched controls per patient. The Social Insurance Institution of Finland provided data on all prescription medications obtained between 1999 and 2012 by patients and controls. Patients were assigned one diagnosis based on a hierarchical list of cardiac defects and dichotomised into simple and severe groups. Medications were divided into short- and long-term based on indication. Follow-up started at the first operation and ended at death, emigration, or 31 December, 2012. Totally, 8623 patients met inclusion criteria. Follow-up was 99.9%. In total, 8126 (94%) patients required prescription medications. Systemic anti-bacterials were the most common short-term prescriptions among patients (93%) and controls (88%). Patients required betablockers (simple hazard ratio 1.9, 95% confidence interval 1.7-2.1; severe hazard ratio 6.5, 95% confidence interval 5.3-8.1) and diuretics (simple hazard ratio 3.2, 95% CI 2.8-3.7; severe hazard ratio 38.8, 95% CI 27.5-54.7) more often than the general population. Both simple and severe defects required medication for cardiovascular, gastrointestinal, psychiatric, neurologic, metabolic, autoimmune, and infectious diseases more often than the general population. The significant risk for postoperative cardiovascular and non-cardiovascular disease warrants close long-term follow-up after congenital heart surgery for all defects.

Analysis of Decisions on Incapacity for Work Issued at the Polish Social Insurance Institution (ZUS) in Relation to Persons with Multiple Sclerosis Before and After the Introduction of Current Drug Treatment Programmes for Multiple Sclerosis in Poland

Aim: The aim of the study was to analyse the decisions on incapacity for work issued at the Polish Social Insurance Institution (ZUS) in the years 2009-2011 and 2016-2018 in relation to people with MS, before and after the introduction of MS drug treatment programmes in Poland, which in connection with the application for rehabilitation or disability pension were examined by a ZUS certifying doctor or ZUS medical board. Materials and Methods: The analysis covered 100 cases, in which in the years 2009-2011 and 2016-2018, in connection with the application for a rehabilitation benefit or a disability pension, a ZUS certifying doctor or ZUS medical board issued a decision on incapacity for work in relation to the same person with the diagnosed SM. Statistical analysis was performed using IBM SPSS Statistics. Results: There were 20% less medical decisions confirming deterioration of health condition related to persons covered by drug programmes compared to the group of persons not participating in these programmes. The asymptotic (two-sided) significance of the cross-tabulation association measure was p = 0.053. In the case of an increase in the number of no-change-in-disability decisions in the group of people covered by the drug programme, the asymptotic (two-sided) significance of the cross-tabulation association measure was p = 0.087. Conclusions: 1. The introduction of immunological therapy that modifies the natural course of multiple sclerosis in patients under the MS drug treatment programmes has significantly reduced the development of their motor disability. 2. As a result, people who have become incapable of work due to this disease have maintained their job or have returned to work, which is particularly important for young patients who are likely to remain economically active for many years to come. 3. Such measures have a significant impact on reducing the number of benefits from the social insurance system.

Determinants in Adopting Online Payments of Individual Payors in a Branch of a Philippine Social Insurance Institution

Determinants in Adopting Online Payments of Individual Payors in a Branch of a Philippine Social Insurance Institution

A FEW REMARKS ON THE APPOINTMENT OF THE PRESIDENT OF THE ZUS (SOCIAL INSURANCE INSTITUTION)

The subject of the article is to discuss the evolution of legal regulations regarding the appointment of the President of the Social Insurance Institution included in the Act of 13 October 1998 on the social insurance system and an assessment whether an employment relationship is established between ZUS and its President on the basis of the appointment.

SUPPLEMENTARY PARENTAL BENEFIT – THE MUM 4 + PROGRAMME – EXPECTATIONS AND REALITY

In this article the regulations of the act on parental supplementary benefit of January 30, 2019 are thoroughly analysed. Supplementary parental benefit is granted to a person who gave birth to and raised or only raised at least four children and did not acquire the right to a pension or a pension paid to this person by the pension authority is smaller than the lowest pension. One is entitled to the benefit mentioned herein only in the case of not having means of subsistence because of not pursuing or discontinuing employment as a result of raising minimum four children. Supplementary parental benefit is in no way related to making social security contributions, it is a benefit financed by the state budget, which in a supplementary or substitutional way is linked to old age. In the legal sense, it is not a pension, but a special non-contributory monetary benefit of discretionary nature, which is granted only on request of the person of interest based on the administrative decision of the president of the Polish Social Insurance Institution (ZUS) or the Agricultural Social Insurance Fund (KRUS).

THE SELF-GOVERNMENT OF SOCIAL INSURANCE INSTITUTIONS AS A SPECIFIC EXPRESSION OF THE SOCIAL PARTNERS’ DIALOGUE ON THE EXAMPLE OF THE EVOLUTION OF THE ZUS SUPERVISORY BOARD

The subject of the article is the self-government of social insurance institutions as a special expression of the social partners’ dialogue. Author discusses this issue on the example of the evolution of the ZUS Supervisory Board, starting from the interwar period, through the Polish People’s Republic, to the presentation of the current regulations governing the composition and competence of the Board

Systemic Antibiotics Influence Periodontal Parameters and Oral Microbiota, But Not Serological Markers.

The use of systemic antibiotics may influence the oral microbiota composition. Our aim was to investigate in this retrospective study whether the use of prescribed antibiotics associate with periodontal status, oral microbiota, and antibodies against the periodontal pathogens. The Social Insurance Institution of Finland Data provided the data on the use of systemic antibiotics by record linkage to purchased medications and entitled reimbursements up to 1 year before the oral examination and sampling. Six different classes of antibiotics were considered. The Parogene cohort included 505 subjects undergoing coronary angiography with the mean (SD) age of 63.4 (9.2) years and 65% of males. Subgingival plaque samples were analysed using the checkerboard DNA-DNA hybridisation. Serum and saliva antibody levels to periodontal pathogens were analysed with immunoassays and lipopolysaccharide (LPS) activity with the LAL assay. Systemic antibiotics were prescribed for 261 (51.7%) patients during the preceding year. The mean number of prescriptions among them was 2.13 (range 1–12), and 29.4% of the prescriptions were cephalosporins, 25.7% penicillins, 14.3% quinolones, 12.7% macrolides or lincomycin, 12.0% tetracycline, and 5.8% trimethoprim or sulphonamides. In linear regression models adjusted for age, sex, current smoking, and diabetes, number of antibiotic courses associated significantly with low periodontal inflammation burden index (PIBI, p < 0.001), bleeding on probing (BOP, p = 0.006), and alveolar bone loss (ABL, p = 0.042). Cephalosporins associated with all the parameters. The phyla mainly affected by the antibiotics were Bacteroidetes and Spirochaetes. Their levels were inversely associated with the number of prescriptions (p = 0.010 and p < 0.001) and directly associated with the time since the last prescription (p = 0.019 and p < 0.001). Significant inverse associations were observed between the number of prescriptions and saliva concentrations of Prevotella intermedia, Tannerella forsythia, and Treponema denticola and subgingival bacterial amounts of Porphyromonas gingivalis, P. intermedia, T. forsythia, and T. denticola. Saliva or serum antibody levels did not present an association with the use of antibiotics. Both serum (p = 0.031) and saliva (p = 0.032) LPS activity was lower in patients having any antibiotic course less than 1 month before sampling. Systemic antibiotics have effects on periodontal inflammation and oral microbiota composition, whereas the effects on host immune responses against the periodontal biomarker species seem unchanged.

Support instruments for professional activation of persons with health issues by the example of services offered by the social insurance institution

Abstract Subject and purpose of work: The presented text concerns possibilities of professional activation of persons with health issues. Due to health issues the affected persons are at the margin of professional, social and family life. In the paper an attempt has been made to present support instruments offered by the Social Insurance Institution to persons with health issues. Materials and methods: Data of Statistics Poland and data generally available on the website www.zus.pl has been used herein. Results: Return to work of persons with health issues is a complex process and concerns a significant number of the working age population. It should be noticed that professional activation of persons with health issues depends on many factors: currently available medical knowledge, access to medical services, as well as the belief in the possibility of returning to work or the access to support within insurance. Conclusions: Coherent programmes and action plans of the Social Insurance Institution develop effective mechanisms supporting return to work of persons with health issues. Key solutions for these persons should focus on their support in solving ongoing problems, as well as conduct activities in the scope of improving working conditions.

Surveillance, Whistleblowing or Ignorance of the GDPR?

Abstract The article is an attempt to draw attention to the intention of the Ministry of Family and Social Policy to shape its own legal policy with regard to the ability of the officials of the Social Insurance Institution (ZUS) to obtain information about individuals subject to official control. Within the proposed changes to Art. 61a of the Act of 25 June 1999 on cash benefits from social insurance in the event of sickness and maternity (Journal of Laws 1999, 60.636, as amended), the Ministry, not taking into account the requirement to ensure the existence of constitutionally guaranteed rights and freedoms, consciously shapes the law positive for full-range surveillance of every person covered by the interest of ZUS. In such circumstances, after adopting the amendments by the Polish Parliament (Sejm), ZUS will be included in the group of law enforcement authorities, as the scope of powers and possibilities its officials in the field have of obtaining information will be unlimited.

Patient-specific and healthcare real-world costs of atrial fibrillation in individuals treated with direct oral anticoagulant agents or warfarin

BackgroundAnticoagulant therapies are used to prevent atrial fibrillation-related strokes, with warfarin and direct oral anticoagulant (DOAC) the most common. In this study, we incorporate direct health care costs, drug costs, travel costs, and lost working and leisure time costs to estimate the total costs of the two therapies.MethodsThis retrospective study used individual-level patient data from 4000 atrial fibrillation (AF) patients from North Karelia, Finland. Real-world data on healthcare use was obtained from the regional patient information system and data on reimbursed travel costs from the database of the Social Insurance Institution of Finland. The costs of the therapies were estimated between June 2017 and May 2018. Using a Geographical Information System (GIS), we estimated travel time and costs for each journey related to anticoagulant therapies. We ultimately applied therapy and travel costs to a cost model to reflect real-world expenditures.ResultsThe costs of anticoagulant therapies were calculated from the standpoint of patient and the healthcare service when considering all costs from AF-related healthcare visits, including major complications arising from atrial fibrillation. On average, the annual cost per patient for healthcare in the form of public expenditure was higher when using DOAC therapy than warfarin therapy (average cost = € 927 vs. € 805). Additionally, the average annual cost for patients was also higher with DOAC therapy (average cost = € 406.5 vs. € 296.7). In warfarin therapy, patients had considerable more travel and time costs due the different implementation practices of therapies.ConclusionThe results indicated that DOAC therapy had higher costs over warfarin from the perspectives of the patient and healthcare service in the study area on average. Currently, the cost of the DOAC drug is the largest determinator of total therapy costs from both perspectives. Despite slightly higher costs, the patients on DOAC therapy experienced less AF-related complications during the study period.

Diseases with oral manifestations among adult asthmatics in Finland: a population-based matched cohort study

ObjectivesMany comorbidities are associated with adult asthma and may exacerbate the asthma burden of disease. This study aims to investigate the risk for major oral diseases or oral-manifesting diseases in...

New technologies in the Social Insurance Institution

The Social Insurance Institution (Zakład Ubezpieczeń Społecznych, ZUS) is one of the largest public institutions in Poland. For nearly nine decades it has been carrying out tasks in the area of social insurance, taking care both of the social security of citizens and the part of public finances it manages. ZUS has solutions which use modern techniques and technologies (so-called e-projects), which are the basic tools for achieving the organisation’s objectives. The text outlines the objectives for ZUS development and related IT instruments in the area of IT over the last five years. Special attention has been paid to the solutions employed by ZUS during the COVID-19 pandemic (from spring 2020), which positively verified their legitimacy and application. The main e-projects have been described. Their role has been indicated and their efficiency assessed.

Prostate Cancer–specific Survival After Radical Prostatectomy Is Improved Among Metformin Users but Not Among Other Antidiabetic Drug Users

BackgroundMetformin has been linked to improved survival among diabetic prostate cancer (PCa) patients, while hyperinsulinemia and insulin usage has been related to worse prognosis. ObjectiveTo evaluate the association of metformin and other antidiabetic drugs with PCa death and androgen deprivation therapy (ADT). Design, setting, and participantsThe study cohort included 14424 men who underwent radical prostatectomy in Finland during 1995–2013. Cases were identified, and clinical data were collected from patient files and national registries using personal identification numbers. InterventionInformation on the use of each antidiabetic drug during 1995–2014 was collected from prescription registry of the Social Insurance Institution of Finland. Outcome measurements and statistical analysisThe risks of PCa death and initiation of ADT were analyzed by antidiabetic drug use with the Cox regression method. Each antidiabetic drug group was analyzed separately to model simultaneous usage. Pre- and postdiagnostic uses were analyzed separately. Results and limitationsPrediagnostic use of antidiabetic drugs in general had no association with the risk of PCa death. Prediagnostic use of metformin was related to a reduced risk of ADT initiation (hazard ratio [HR] 0.75, 95% confidence interval [CI] 0.59–0.96), while high-dose insulin users had an increased risk. Overall, antidiabetic drug use after PCa diagnosis was associated with an elevated risk of PCa death. Only postdiagnostic metformin use was associated with reduced risks of PCa death (HR 0.47, 95% CI 0.30–0.76) and ADT initiation compared with nonusers. Study limitations are missing information on glycemic control, smoking, living or exercise habits, prostate-specific antigen, and Gleason score. ConclusionsAmong surgically treated PCa patients, use of metformin was associated with improved disease-specific survival, while insulin and insulin secretagogues were associated with poor survival. Metformin might be a favorable diabetes treatment among men with PCa. Patient summaryIn this Finnish nationwide study, we found that the risks of prostate cancer death and cancer progression are lowered among metformin users, but not among other antidiabetic drug users. Metformin might be a favorable treatment choice for diabetes in men with prostate cancer.

Sickness absence during the COVID-19 pandemic

The aim of this research was to perform comparative analysis of the publicly avaiable data of the Social Insurance Institution (ZUS) on sickness absence of insured persons in Poland in 2016-2021 (before the outbreak and during the COVID-19 pandemic).&#x0D; Materials and methods. The research material consisted of data from the Social Insurance Institution for the years 2016-2021 (Q1) concerning the sickness absence of the insured. Due to the publication of data in an aggregated form, quantitative analysis was performed instead of statistical analysis. The data used in the analysis included the number of insured persons, the number of people receiving sickness benefits, the number of issued medical certificates on temporary incapacity to work and the reasons for the incapacity to work.&#x0D; Results and Conclusion. Since the beginning of the COVID-19 pandemic, following numbers have increased compared to 2019: the number of people receiving sickness benefit in Poland (by 10%), the number of days of sickness absence (by 7%) and the number of issued medical certificates of temporary incapacity for work (by 4%). The largest increase in the number of beneficiaries, the number of days of sickness absence and the number of medical certificates was recorded in the Q4 of 2020 (respectively by 21%, 16% and 24% compared to Q4 of 2019). Due to COVID-19, 4.84 million days of sickness absence were used in 2020 – it was the tenth cause of absence.&#x0D; The largest changes in the number of people receiving sickness benefit and the number of days of sickness absence can be observed in Q1 and Q4, which may result from the seasonality of COVID-19 and the subsequent wave of infections. Importantly, COVID-19 is not the only factor contributing overall increase in the number of days of sickness absence in Poland – absence due to non-communicable diseases also increased during the pandemic.

E-SERVICES IN PUBLIC ADMINISTRATION ON THE BASIS OF THE POLISH SOCIAL INSURANCE INSTITUTION (ZUS)

The term e-services refers to such services that are delivered over the Internet and their rendition is frequently automated and remote. Apart from the Internet, an e-service may also be provided by means of mobile devices or television. The wider and wider range of e-services is offered by institutions from the public administration sector, striving to anticipate their client's expectations (especially those of the younger generation) and using the ongoing digitisation process. This study aims at presenting the role and opinions of e-service in one of the social insurance institutions, i.e. Social Insurance Institution (ZUS) where numerous electronic tools have been implemented facilitating work and enabling clients to make contact, get information, send and receive documents. All these efforts are made so as to increase accessibility for prospective and current clients as well as to make the institution's operations more efficient. To achieve this, the following research methods were used: a critical analysis of the literature, an analysis of statistical data, an analysis of survey results (conducted by ZUS), and a survey questionnaire (own research).

Increased risk for dementia in neurofibromatosis type 1

PurposeTo determine the risk for dementia in neurofibromatosis type 1 (NF1) using a Finnish nationwide cohort of individuals with NF1, and data from national registries. MethodsA Finnish cohort of 1,349 individuals with confirmed NF1 according to the US National Institutes of Health (NIH) diagnostic criteria was compared with a control cohort of 13,870 individuals matched for age, sex, and area of residence. Dementia-related hospital visits were retrieved from the Finnish Care Register for Health Care using International Classification of Diseases, 10th revision (ICD-10) diagnosis codes G30 and F00–F03. Purchases of antidementia drugs were queried with Anatomical Therapeutic Chemical (ATC) classification code N06D from the drug reimbursement register maintained by the Social Insurance Institution of Finland. The follow-up spanned 1998–2014. ResultsTotals of 16 and 165 individuals with at least two dementia-related diagnoses or drug purchases were identified in the NF1 and control cohorts, respectively. The hazard ratio for dementia in NF1 was 1.67 (95% confidence interval [CI] 1.00–2.80, P = 0.050). In an analysis stratified by the type of dementia, the risk for Alzheimer disease was increased in NF1 compared to controls with a hazard ratio of 2.88 (95% CI 1.47–5.66, P = 0.002). ConclusionDementia and especially Alzheimer disease are previously unrecognized neurological complications of NF1.