Profiling Bispebjerg Acute Cohort: Database Formation, Acute Contact Characteristics of a Metropolitan Hospital, and Comparisons to Urban and Rural Hospitals in Denmark

Abstract

Purpose

To present a metropolitan cohort, Bispebjerg acute cohort (BAC), and compare patient characteristics and outcomes with patients from urban and rural hospitals in Denmark.

Patients and Methods

We linked data from seven Danish nationwide registries and included all acute contacts to non-psychiatric hospitals in the years 2016–2018. Acute hospital contacts to Bispebjerg and Frederiksberg Hospital constituted BAC, representing a solely metropolitan/urban catchment area. Patient characteristics and outcomes were compared to the rest of Denmark in an urban cohort (UrC) and a rural cohort (RuC), stratified by visit and hospitalization contact types.

Results

We identified 4,063,420 acute hospital contacts in Denmark and BAC constituted 8.4% (n=343,200) of them. BAC had a higher proportion of visits (65.1%) compared with UrC (52.1%) and RuC (45.3%). Patients in BAC more often lived alone (visits: BAC: 34.8%, UrC: 30.6%, RuC: 29.2%; hospitalizations: BAC: 50.8%, UrC: 36.7%, RuC: 37.2%) and had temporary CPR number (visits: BAC: 4.4%, UrC: 1.9%, RuC: 1.6%; hospitalizations: BAC: 1.5%, UrC: 0.9%, RuC: 0.8%). Visit patients in BAC were younger (BAC: 36, UrC: 42, RuC: 45 years, median), more often students (BAC: 18.0%, UrC: 14.0%, RuC: 12.5%), and had more contacts due to infectious diseases (BAC: 19.8%, UrC: 14.1%, RuC: 6.2%) but less due to injuries (BAC: 40.0%, UrC: 43.8%, RuC: 60.7%). Hospitalized patients in BAC had higher median age (BAC: 64, UrC: 61, RuC: 64 years) and fewer were in employment than in UrC (BAC: 26.1%, UrC: 32.1%, RuC: 28.1%). BAC Hospitalizations had a lower death rate within 30 days than in RuC (BAC: 3.0% [2.9–3.1%], UrC: 3.1% [3.0–3.1%], RuC: 3.4% [3.3–3.4%]), but a higher readmission-rate (BAC: 20.5% [20.3–20.8%], UrC: 17.3% [17.2–17.4%], RuC: 17.5% [17.5–17.6%]).

Conclusion

Significant differences between BAC, urban, and rural cohorts may be explained by differences in healthcare structure and sociodemographics of the catchment areas.

Keywords:

• emergency medicine
• acute care
• urban-rural disparities
• registry-based research
• Danish national registers
• epidemiology

Abbreviations

BAC, Bispebjerg acute cohort; BFH, Bispebjerg and Frederiksberg Hospital; CPR, Det Centrale Personregister; DNPR, Danish National Patient Registry; ED, emergency department; GPs, general practitioners; RLRR, Register of Laboratory Results for Research; RuC, rural cohort; UrC, urban cohort.

Data Sharing Statement

Since the data is protected by Danish legislations, it cannot be made available neither publicly, nor privately. Approved Danish research institutions can apply for an equivalent data material through Statistics Denmark and the Danish Health Data Authority.

Ethics Approval and Informed Consent

According to Danish law, ethical approval is not needed for registry-based studies. The project was approved by Statistics Denmark (project number: 707838) and the Data Protection Agency (P-2019-616).

Acknowledgments

We would like to express our thanks to Diana Kali for providing linguistic support. Further, we thank Karina Aaroe Grossmeyer at RegionH Design for producing Figure 1.

Author Contributions

Initial conceptualization: Finn E. Nielsen, Janne Petersen, Rasmus Gregersen, Henriette Husum Bak-Jensen, Allan Linneberg, Olav Wendelboe Nielsen, Simon Francis Thomsen, Christian S. Meyhoff, Kim Dalhoff, Michael Krogsgaard, Henrik Palm, Hanne Christensen, Celeste Porsbjerg, Kristian Antonsen, Steen B. Haugaard, and Jørgen Rungby. Data acquisition and methodology: Rasmus Gregersen, Cathrine Fox Maule, Henriette Husum Bak-Jensen, Janne Petersen, and Finn E. Nielsen. Data management and formal analysis: Rasmus Gregersen and Cathrine Fox Maule. Primary investigator and writing initial draft: Rasmus Gregersen. Primary supervision and revision: Janne Petersen and Finn E. Nielsen Visualization: RegionH Design, under instructions from Rasmus Gregersen. Funding acquisition: Finn E. Nielsen, Janne Petersen, Henriette Husum Bak-Jensen, Allan Linneberg, Olav Wendelboe Nielsen, Simon Francis Thomsen, Christian S. Meyhoff, Kim Dalhoff, Michael Krogsgaard, Henrik Palm, Hanne Christensen, Celeste Porsbjerg, Steen B. Haugaard, and Kristian Antonsen. All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; all authors have agreed upon submission to Clinical Epidemiology, have provided final approval, and take full responsibility for all aspects and contents of the work.

Disclosure

Professor Olav Wendelboe Nielsen reports speaker fees from Novartis and Roche, outside the submitted work. Dr Christian S Meyhoff reports indirect research grants from Boehringer Ingelheim to his department, research grants from Merck, Sharp & Dohme to his department, personal fees for research and lecture from Radiometer, outside the submitted work; In addition, Dr Christian S Meyhoff has a patent “Wireless Assessment of Respiratory and circulatory Distress (WARD) – Clinical Support System (CSS) - an automated clinical support system to improve patient safety and outcomes” pending to WARD 247 ApS, which he is a co-founder. The authors report no other conflicts of interest in this work.

Additional information

Funding

The project was financed by the Bispebjerg and Frederiksberg Hospital Research Committee Fund, the Center for Translational Research, and the Department of Emergency Medicine.