Respiratory symptoms increase health care consumption and affect everyday life – a cross-sectional population-based study from Finland, Estonia, and Sweden

Figures & data

Table 1 Basic characteristics of the study population by country and sex

	All subjects			Males			Females
	Finland (n=1,337)	Estonia (n=1,346)	Sweden (n=1,953)	Finland (n=597)	Estonia (n=612)	Sweden (n=971)	Finland (n=740)	Estonia (n=734)	Sweden (n=982)
Age, mean (SD)	44.8 (13.1)	43.8 (12.9)	45.7 (13.4)	45.3 (13.2)	44.1 (13.2)	46.2 (13.4)	44.5 (12.9)	43.5 (12.8)	45.3 (13.4)
Male, n (%)	597 (44.7)	612 (45.5)	971 (49.7)
BMI	26.12 (4.5)	25.87 (4.5)	25.45 (3.9)	26.45 (3.8)	25.90 (4.1)	25.38 (5.3)	25.91 (5.0)	25.85 (4.8)	24.22 (5.8)
<20, n (%)	53 (4.0)	60 (5.0)	87 (4.6)	9 (1.5)	15 (2.7)	18 (1.9)	44 (5.9)	45 (6.9)	69 (7.3)
20–25, n (%)	569 (42.6)	521 (43.6)	879 (46.4)	225 (37.8)	248 (45.3)	392 (41.6)	344 (46.5)	273 (42.1)	487 (51.3)
25–30, n (%)	481 (36.0)	425 (35.5)	694 (36.7)	268 (45.0)	213 (38.9)	406 (43.1)	213 (28.8)	212 (32.7)	288 (30.3)
>30, n (%)	233 (17.4)	190 (15.9)	233 (12.3)	94 (15.8)	72 (13.1)	127 (13.5)	139 (18.8)	118 (18.2)	106 (11.2)
Smoking status
Current smokers, n (%)	378 (28.3)	472 (35.1)	458 (23.5)	195 (32.7)	304 (49.7)	223 (23.0)	183 (24.7)	168 (22.9)	235 (23.9)
Ex-smokers, n (%)	380 (28.4)	234 (17.4)	579 (29.6)	216 (36.2)	156 (25.5)	313 (32.2)	164 (22.2)	78 (10.6)	266 (27.1)
Non-smokers, n (%)	579 (43.3)	638 (47.4)	908 (46.5)	186 (31.2)	151 (24.7)	433 (44.6)	393 (53.1)	487 (66.4)	475 (48.3)
Working status
Studying, n (%)	38 (2.8)	18 (1.3)	70 (3.6)	15 (2.5)	5 (0.8)	19 (2.0)	23 (3.1)	13 (1.8)	51 (5.2)
Working, n (%)	809 (60.5)	923 (68.6)	1312 (67.2)	378 (63.3)	442 (72.2)	670 (69.6)	431 (58.2)	481 (65.5)	642 (65.6)
Job seeker, n (%)	109 (8.2)	91 (6.8)	89 (4.6)	44 (7.4)	45 (7.4)	47 (4.9)	65 (8.8)	46 (6.3)	42 (4.3)
Disability pension, n (%)	134 (10.1)	81 (6.1)	205 (10.5)	48 (8.1)	45 (7.4)	106 (11.0)	86 (11.6)	36 (4.9)	99 (10.1)
Old age pension, n (%)	162 (12.1)	181 (13.4)	209 (10.7)	82 (13.7)	62 (10.1)	102 (10.6)	80 (10.8)	119 (16.2)	107 (10.9)
Other, n (%)	85 (6.4)	52 (3.8)	68 (3.5)	30 (5.0)	13 (2.1)	19 (2.0)	55 (7.4)	39 (5.4)	37 (3.7)

SD=Standard deviation, BMI=body mass index.

Table 2 Comparing prevalence (%) of respiratory symptoms between countries, in the total study population and stratified by sex

	Country				Males				Females
	Finland	Estonia	Sweden	p ^#	Finland	Estonia	Sweden	p ^#	Finland	Estonia	Sweden	p ^#
Any respiratory symptoms during the past 12 months	66.0	65.2	54.1	F/E^ns F/S*** E/S***	66.8	67.8	52.9	F/E^ns F/S*** E/S***	65.4	63.1	55.3	F/E^ns F/S*** E/S***
Recurrent morning cough	23.2	24.1	29.2	F/E^ns F/S*** E/S***	24.5	29.6	29.7	F/E* F/S* E/S^ns	22.2	19.5	28.8	F/E^ns F/S** E/S***
Recurrent day- or night-time cough	26.6	25.0	27.9	F/E^ns F/S^ns E/S^ns	24.8	24.2	26.2	F/E^ns F/S^ns E/S^ns	28.1	25.7	29.6	F/E^ns F/S^ns E/S^ns
Recurrent sputum production: • Now and then • Often	39.0 11.1	41.3 8.6	19.6 10.1	F/E^ns F/S*** E/S***	40.9 12.4	43.3 11.1	18.7 12.2	F/E^ns F/S*** E/S***	37.6 10.0	39.6 6.5	20.4 8.0	F/E^ns F/S*** E/S***
Wheeze in the past 12 months	23.7	27.0	27.8	F/E^ns F/S** E/S^ns	24.8	32.2	28.3	F/E** F/S^ns E/S^ns	22.8	22.6	27.3	F/E^ns F/S* E/S*
Attacks of shortness of breath in the past 12 months	14.8	13.8	15.3	F/E^ns F/S^ns E/S^ns	12.9	11.1	14.0	F/E^ns F/S^ns E/S^ns	16.4	16.1	16.6	F/E^ns F/S^ns E/S^ns

F=Finland, E=Estonia, S=Sweden, ns=non-significant. p>0.05, p<0.05, **p<0.01, ***p<0.001, p-values based on Chi-square test and Mantel–Haenszel test in variables with more than two response alternatives.

Table 3 Respiratory symptoms and number of respiratory symptoms^a in relation to health care consumption in the general population analyzed by multiple logistic regression analyses expressed as odds ratio (OR) with 95% CI, adjusted for country, sex, age, BMI, smoking status

	Outpatient care during the last year		Regular outpatient care		Specialist consultations		Hospitalisations
Symptom	OR	95% CI	OR	95% CI	OR	95% CI	OR	95% CI
Recurrent morning cough	1.20	0.95–1.52	1.09	0.70–1.70	1.28	0.98–1.67	1.10	0.82–1.48
Recurrent day- and night-time cough	1.49	1.19–1.85	1.49	0.98–2.28	1.37	1.07–1.75	1.39	1.06–1.84
Recurrent sputum production
Now and then	1.63	1.29–2.05	1.88	1.16–3.03	1.30	1.00–1.70	1.48	1.10–1.98
Often	2.10	1.51–2.90	2.41	1.33–4.34	1.86	1.30–2.66	1.65	1.09–2.49
Wheeze in the past 12 months	3.00	2.41–3.72	4.72	3.01–7.42	2.95	2.31–3.76	2.60	1.97–3.44
Number of symptoms^a
0 symptoms	1		1		1		1
1 symptom	2.89	2.06–4.05	8.24	2.33–29.06	2.56	1.78–3.68	2.34	1.55–3.53
2 symptoms	5.66	4.05–7.91	29.97	9.10–98.66	4.90	3.41–7.04	3.63	2.39–5.50
3 symptoms	8.87	6.28–12.52	35.28	10.54–118.05	6.10	4.15–8.97	5.39	3.52–8.25
4 symptoms	14.12	9.82–20.30	79.59	24.03–263.66	13.91	9.44–20.50	9.13	5.87–14.21
5 symptoms	28.71	18.33–44.96	169.32	49.75–576.25	29.49	18.45–47.13	16.23	9.58–27.49

Negative answers as reference in each variable.

Significant risk factors are depicted in bold. ^aA cumulative symptom score based on the following symptoms: Recurrent morning cough, Recurrent day- and night-time cough, Recurrent sputum production, Wheeze in the past 12 months, Attacks of shortness of breath in the past 12 months. The variable ‘Number of symptoms’ was not analysed in the same multiple regression model as the symptoms.

Table 4 Comparing health care consumption (%) among subjects with any respiratory symptoms during the past 12 months between countries, in the total study population and by sex

	Country				Males				Females
	Finland	Estonia	Sweden	p ^#	Finland	Estonia	Sweden	p ^#	Finland	Estonia	Sweden	p ^#
Outpatient care during	19.0	18.8	17.2	F/E^ns	14.8	13.3	14.8	F/E^ns	22.5	23.8	19.5	F/E^ns
the past 12 months				F/S^ns				F/S^ns				F/S^ns
				E/S^ns				E/S^ns				E/S^ns
Regular outpatient care	3.2	4.7	6.4	F/E^ns	2.8	3.6	6.8	F/E^ns	3.5	5.6	6.1	F/E^ns
				F/S***				F/S**				F/S^ns
				E/S^ns				E/S*				E/S^ns
Specialist consultations	19.1	9.9	12.6	F/E***	18.0	6.7	10.7	F/E***	20.0	12.7	14.4	F/E**
				F/S***				F/S***				F/S*
				E/S^ns				E/S*				E/S^ns
Hospitalisations	8.8	15.0	6.5	F/E***	7.8	14.9	6.4	F/E***	9.7	15.1	6.6	F/E*
				F/S^ns				F/S^ns				F/S^ns
				E/S***				E/S***				E/S***

F=Finland, E=Estonia, S=Sweden, ns=non-significant. p>0.05, *p<0.05, **p<0.01, ***p<0.001, ^# p-values based on Chi-square test.

Table 5 Risk factors associated with health care consumptions assessed as outpatient care during the past 12 months expressed as odds ratio (OR) with 95% CI, analysed by multiple logistic regression analyses in the total study population and stratified by country

	Risk factors for outpatient care during the last 12 months
	All subjects		Finland		Estonia		Sweden
	OR	95% CI	OR	95% CI	OR	95% CI	OR	95% CI
Country
Sweden	1
Finland	1.38	1.12–1.72
Estonia	1.30	1.04–1.64
Sex
Male	1		1		1		1
Female	1.75	1.44–2.12	1.76	1.26–2.45	2.16	1.46–3.20	1.53	1.12–2.07
Age^a	1.00	0.99–1.01	1.01	1.00–1.03	1.00	0.98–1.01	0.99	0.98–1.00
BMI
20–25	1				1		1
<20	0.49	0.28–0.89	0.48	0.17–1.40	0.22	0.05–0.92	0.83	0.37–1.88
>25–30	1.31	1.07–1.62	0.95	0.66–1.36	1.72	1.16–2.55	1.40	0.99–1.98
>30	1.53	1.18–1.98	1.29	0.85–1.97	1.50	0.91–2.48	1.88	1.20–2.92
Smoking status
Non-smokers	1				1		1
Ex-smokers	1.24	0.99–1.56	1.72	1.18–2.50	0.93	0.55–1.57	1.12	0.79–1.61
Current smokers	1.21	0.96–1.50	1.37	0.93–2.03	1.14	0.78–1.72	1.13	0.78–1.66
Working status
Working/studying	1		1		1		1
Not working	1.15	0.91–1.45	0.76	0.51–1.14	1.23	0.78–1.92	1.72	1.17–2.52
Old age pension	1.00	0.70–1.14	0.92	0.51–1.66	0.63	0.33–1.20	1.44	0.79–2.61

^aContinuous variable. BMI=body mass index. Significant risk factors are depicted in bold.

Fig. 1 The impact of respiratory symptoms on everyday life among subjects with any respiratory symptoms during the past 12 months based on Mantel–Haenszel test for trends.

Fig. 2 The impact of respiratory symptoms on everyday life among males and females with any respiratory symptoms during the past 12 months based on Mantel–Haenszel test for trends.

Table 6 Respiratory symptoms and number of respiratory symptoms in relation to experienced impact, moderately to severely, on everyday life analysed by unadjusted logistic regressions and multiple regression models expressed as odds ratio (OR) with 95% CI, adjusted for country, sex, age, BMI, and smoking status

	Unadjusted analyses		Adjusted analyses
	Impact on everyday life^a		Impact on everyday life^a
Symptom	OR	95% CI	OR	95% CI
Recurrent morning cough	3.05	2.46–3.78	1.59	1.21–2.10
Recurrent day- and night-time cough	3.12	2.51–3.87	1.86	1.44–2.42
Recurrent sputum production
Now and then	2.04	1.59–2.63	1.40	1.03–1.90
Often	4.61	3.45–6.15	2.28	1.57–3.31
Wheeze in the past 12 months	3.50	2.81–4.37	2.09	1.61–2.71
Attacks of shortness of breath in the past 12 months	4.42	3.54–5.51	2.89	2.24–3.72
Number of symptoms^b
0 symptoms	1		1
1 symptom	3.17	1.77–5.68	3.37	1.84–6.16
2 symptoms	5.65	3.23–9.87	6.42	3.60–11.45
3 symptoms	7.91	4.56–13.71	8.80	4.94–15.68
4 symptoms	19.93	11.49–34.57	23.77	13.32–42.41
5 symptoms	38.49	20.96–70.65	41.61	21.92–79.01

Significant risk factors are depicted in bold. ^aIn the unadjusted analyses, the respiratory symptoms were analysed separately one by one and in the adjusted analyses all respiratory symptoms were entered in the same model and adjusted for country, sex, age, BMI, and smoking status. ^b Number of symptoms was not analysed in the same multiple regression model as the symptoms. Negative answers as reference in each variable.