Active listing and more consultations in primary care are associated with shorter mean hospitalisation and interacting with psychiatric disorders when adjusting for multimorbidity, age and sex

Figures & data

Table 1. Descriptive for the population of Blekinge in 2007 (N = 151 731).

Descriptive	Group size		Admitted to hospital		Hospitalisation for the group		Hospital days
	n	%	n	%	Total days	%	Mean
No psychiatric disorder	144 602	95.3	11 463	87.4	100 139	74.0	0.69
Any psychiatric disorder	7 129	4.7	1 659	12.6	35 323	26.0	4.95
Psychoses	193	0.1	55	0.4	2 466	1.8	12.77
Depressive disorders	2 348	1.6	549	4.2	12 513	9.2	5.33
Anxiety disorders	2 133	1.4	396	3.0	6 685	4.9	3.13
Others	2 455	1.6	659	5.0	13 659	10.1	5.56
Passively listed	53 131	35.0	3 338	25.4	31 484	23.3	0.59
Actively listed	98 600	65.0	9 784	74.6	103 978	76.7	1.05
0 or 1 consultation	118 759	78.3	8 269	63.0	79 979	59.1	0.67
2 or 3 consultations	23 981	15.8	3 003	22.9	32 822	24.3	1.37
4 or 5 consultations	6 367	4.2	1 184	9.0	13 545	10.0	2.13
6 or 7 consultations	1 740	1.2	392	3.0	4 828	3.6	2.77
8- consultations	884	0.6	274	2.1	4 288	3.2	4.85
RUB 0	60 911	40.1	22	0.2	289	0.0	0.00
RUB 1	20 586	13.6	1 340	10.2	5 746	4.2	0.28
RUB 2	33 551	22.1	2 153	16.4	14 108	10.4	0.42
RUB 3	32 651	21.5	7 133	54.4	66 690	49.3	2.04
RUB 4	3 398	2.2	1 965	15.0	31 564	23.3	9.29
RUB 5	634	0.4	509	3.9	17 065	12.6	26.92
Women	75 087	49.5	7 078	53.9	73 455	54.3	0.98
Men	76 644	50.5	6 044	46.1	62 007	45.7	0.81
0–19 years	33 096	21.8	1 179	9.0	8 308	6.1	0.25
20–39 years	35 297	23.3	3 651	27.8	26 600	19.7	0.75
40–59 years	39 667	26.1	2 285	17.4	21 707	16.0	0.55
60–79 years	33 786	22.3	3 725	28.4	46 604	34.4	1.38
80+ years	9 885	6.5	2 282	17.4	32 243	23.8	3.26
Population of Blekinge	151 731		13 122		135 297		0.89

Unadjusted hospitalisation during 2007 distributed on explanatory factors for the population of Blekinge.

Table 2. Clustered zero-inflated negative binomial regression for the population of Blekinge in 2007 (N = 151 731). Mean days hospitalised calculated as average marginal effects.

Multivariate regression	Odds ratio for any hospital admission, population		Rate ratio of days hospitalised, population at risk		Mean days hospitalised, population
	OR	(95%CI)	IRR	(95%CI)	Days	(95%CI)
No psychiatric disorder	1.00		1.00		0.76	(0.72–0.79)
Psychoses	0.77	(0.47–1.08)	7.05	(4.97–10.01)	4.67	(2.77–6.57)
Depressive disorders	0.81	(0.69–0.92)	2.81	(2.43–3.26)	1.90	(1.61–2.18)
Anxiety disorders	0.78	(0.65–0.92)	2.45	(1.97–3.05)	1.63	(1.23–2.03)
Others	0.90	(0.74–1.07)	2.37	(1.98–2.82)	1.69	(1.32–2.07)
Passively listed	1.00		1.00		1.23	(1.09–1.37)
Actively listed	0.67	(0.58–0.76)	0.84	(0.77–0.93)	0.86	(0.81–0.92)
0 or 1 consultation	1.00		1.00		1.16	(1.08–1.23)
2 or 3 consultations	0.41	(0.31–0.50)	0.89	(0.83–0.96)	0.74	(0.67–0.81)
4 or 5 consultations	0.53	(0.40–0.67)	0.76	(0.70–0.84)	0.68	(0.62–0.75)
6 or 7 consultations	0.51	(0.32–0.70)	0.74	(0.61–0.89)	0.65	(0.54–0.77)
8- consultations	0.73	(0.47–1.00)	0.82	(0.65–1.03)	0.82	(0.57–1.07)
RUB 0	1.00		1.00		0.00	(0.00–0.01)
RUB 1	6.63	(5.93–7.33)	0.29	(0.15–0.59)	0.31	(0.27–0.36)
RUB 2	6.71	(6.00–7.43)	0.39	(0.21–0.71)	0.44	(0.40–0.49)
RUB 3	8.28	(7.60–8.96)	0.51	(0.27–0.95)	2.00	(1.87–2.12)
RUB 4	9.97	(9.29–10.66)	0.93	(0.50–1.76)	8.14	(7.47–8.80)
RUB 5	11.26	(10.58–11.95)	1.79	(0.95–3.38)	20.13	(17.38–22.87)
Women	1.00		1.00		0.90	(0.84–0.96)
Men	1.14	(1.09–1.19)	0.99	(0.94–1.04)	0.96	(0.89–1.03)
0–19 years	1.00		1.00		0.55	(0.49–0.61)
20–39 years	1.96	(1.85–2.07)	0.98	(0.90–1.08)	0.95	(0.85–1.05)
40–59 years	1.01	(0.87–1.14)	1.04	(0.93–1.17)	0.58	(0.52–0.64)
60–79 years	1.10	(0.98–1.23)	1.60	(1.44–1.78)	0.94	(0.88–1.01)
80+ years	1.66	(1.53–1.78)	1.89	(1.69–2.12)	1.55	(1.42–1.68)

OR: odds ratio; IRR: incidence rate ratio; CI: confidence interval; RUB: Resource Utilization Band; p < 0.01 when significance; Odds ratio of hospitalisation: logit part of the regression; Rate ratio of days hospitalised: negative binomial part of the regression including only the population at risk; Mean days hospitalised: calculated average marginal effects for the population, combining both parts of the zero-inflated negative binomial model.

Figure 1. Predicted mean days hospitalised according to listing status and number of consultations in primary care for the population without (N = 144 602) and with (N = 7 129) psychiatric disorders, adjusting for multimorbidity level, age and sex.

Table 3. Predicted mean days hospitalised according to listing, number of consultations in primary care and multimorbidity level for the population without (N = 144 602) and with (N = 7 129) psychiatric disorders.

Adjusted mean days hospitalised	Actively listed		Passively listed
	Days	(95%CI)	Days	(95%CI)
Population without psychiatric disorder
0 or 1 consultation	0.77	(0.73–0.81)	1.10	(0.98–1.21)
2 or 3 consultations	0.48	(0.44–0.52)	0.70	(0.60–0.80)
4 or 5 consultations	0.45	(0.40–0.49)	0.65	(0.54–0.75)
6 or 7 consultations	0.42	(0.34–0.50)	0.61	(0.47–0.75)
8- consultations	0.54	(0.37–0.71)	0.78	(0.51–1.04)
Population with psychiatric disorders
0 or 1 consultation	7.53	(6.46–8.60)	10.23	(8.70–11.75)
2 or 3 consultations	5.10	(4.30–5.90)	7.08	(5.82–8.33)
4 or 5 consultations	4.65	(4.05–5.25)	6.42	(5.41–7.44)
6 or 7 consultations	4.43	(3.65–5.21)	6.12	(4.92–7.32)
8- consultations	5.47	(3.87–7.08)	7.51	(5.25–9.76)
Population without psychiatric disorder
RUB 0	0.00	(0.00–0.01)	0.01	(0.00–0.01)
RUB 1	0.25	(0.21–0.28)	0.39	(0.32–0.46)
RUB 2	0.35	(0.31–0.39)	0.56	(0.49–0.62)
RUB 3	1.64	(1.50–1.77)	2.41	(2.22–2.60)
RUB 4	6.97	(6.45–7.50)	9.09	(7.97–10.20)
RUB 5	17.53	(15.37–19.69)	21.53	(17.79–25.27)
Population with psychiatric disorders
RUB 2	0.70	(0.56–0.84)	1.12	(0.89–1.34)
RUB 3	3.45	(2.84–4.07)	5.17	(4.36–5.98)
RUB 4	16.37	(14.04–18.69)	21.75	(18.58–24.93)
RUB 5	43.93	(35.77–52.10)	54.52	(43.64–65.41)

Adjusted mean days hospitalised calculated as marginal effects from the multivariate negative binomial model adjusted also for consultations, age and sex; Mean days hospitalised calculated separately according to listing status for the populations with and without psychiatric disorders; None with psychiatric disorder in RUB 0–1; CI: Confidence Interval.

Figure 2. Predicted mean days hospitalised according to listing status and multimorbidity level for the population without (N = 144 602) and with (N = 7 129) psychiatric disorders, adjusting for number of consultations, age and sex.