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No previous studies on the association of smoking behaviour with disability retirement due to register verified chronic obstructive pulmonary disease (COPD) exist. This 30-yr follow-up study examined how strongly aspects of cigarette smoking predict disability retirement due to COPD. The study population consisted of 24,043 adult Finnish twins (49.7% females) followed from 1975 to 2004. At baseline the participants had responded to a questionnaire. Information on retirement was obtained from the Finnish pension registers. Smoking strongly predicted disability retirement due to COPD. In comparison to never-smokers, age adjusted hazard ratio (HR) for current smokers was 22.0 (95% CI 10.0-48.5) and for smokers with ≥ 12 pack-yrs was 27.3 (95% CI 12.6-59.5). Similar estimates of risk were observed in within-pair analyses of twin pairs discordant for disability retirement due to COPD. Among discordant monozygotic pairs those with disability pension due to COPD were more often current smokers. The effect of early smoking onset (< 18 yrs) on the risk of disability retirement due to COPD remained after adjustment for the amount smoked (HR 1.70, 95% CI 1.08-2.68). Smoking strongly predicts disability retirement due to COPD. Preventive measures against disability retirement and other harmful consequences of tobacco smoking should receive greater emphasis.

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AIM: To discuss trends based on data on all asthma-related admissions of children under 15 years of age. METHODS: retrospective analysis of records of the Finnish National Research and Development Centre for Welfare and Health in 1996-2004. The analysis was stratified for age. RESULTS: Out of the total of 23,715 such admissions, 66.8% involved boys. The number of all admissions for boys aged 0-under 3 years declined by 42.7% (relative to the child population) between 1996 and 2004, that for boys aged 3-under 5 years by 55.1% and that for boys aged 5-under 15 years by 59.0%, the figures for the corresponding age groups of girls being 53.0, 48.7 and 66.1%, respectively. The overall rate of first admissions for asthma among children (relative to population) declined by 36.8% during that period. CONCLUSIONS. The hospitalization of children for asthma has declined in Finland in recent times in all age and both sex groups. This favourable development coincides with the systematically programmed national shift into effective anti-inflammatory therapy in the paediatric age groups.

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BACKGROUND: Hospitalisation periods for the acute exacerbation phase of COPD are a strain on health facilities and entail high rates of hospital mortality. The aim of this study was to ascertain the characteristics of treatment periods resulting in death and the risk factors involved on the basis of treatment registers and death certificates. METHODS: Data on all treatment periods for persons over 44 years of age with a principal diagnosis of COPD that began as emergency admissions applying to the period 1993-2001 was gathered from the hospital treatment register maintained by the Finnish National Research and Development Centre for Welfare and Health, yielding a total of 72 896 cases. Data on the deaths of the patients concerned was then obtained from Statistics Finland and those treatment periods which could be shown to have ended in death (N = 2331) were taken to form the material for analysis. These were compared with a same number of control hospitalisation periods (not ending in death) in terms of specialisation, type and geographical location of the hospital, length of the treatment period and the occurrence of subsidiary diagnoses. Attention was also paid to the season of the year and the days of the week on which admission and death took place. RESULTS: The proportion of emergency admissions that ended in death was 3.2%, The patients concerned having a mean age of 74.5 years for men and 75.0 years for women on admission. The mean duration of the treatment period was 11.5 days (SD 14.8), compared with 8.0 days (SD 7.9) for the controls. A subsidiary diagnosis existed in the case of 53.6% of the periods ending in death and 37.5% of the control periods. Deaths were most frequent on Fridays, 15.6%, and least so on Tuesdays, 13.0%. Where 24.2% of patients admitted on Saturdays or Sundays died during the first 24 hours, the figure for those admitted on weekdays was only 17.7%. Altogether 62.8% of the treatment periods ending in death took place between December and May. CONCLUSIONS: The COPD patients admitted at weekends showed the poorest survival, while concurrent diseases and protraction of the treatment period in winter and early spring increased the risk of death. Recognition of risk cases on admission could enable mortality to be reduced and allow savings in terms of costs through the intensification of treatment in these cases.

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The aim of this study is to describe the long-term hospital treatment provided for chronic obstructive pulmonary disease (COPD) patients in Finland in 1972-2001 and changes over that period. Data on all treatment periods for persons aged over 45 years with a primary or secondary diagnosis of COPD (International Classification of Diseases - ICD 8: 491 and 492, ICD 9: 491, 492 and 496, ICD 10: J41-J44) beginning in the years 1972-2001 were gathered from the treatment register of the Finnish National Research and Development Centre for Welfare and Health and examined particularly with respect to long treatment periods (over 90 days). A total of 10,176 long treatment periods were recorded as having begun during the years in question. The number of treatment periods for men dropped by 65.8% over the time interval 1972-2001, while that for women increased by 4.7%. The number of treatment periods in university and central hospitals dropped by 97.6%. The total number of hospitalization days in the long treatment periods over the years 1972-2001 was 3,844,521, the men accounting for 82.9% in 1972-1976 and 67.3% in 1997-2001. The number of days required by men dropped by 82.1% and that for women by 57.8%. The number of days in university and central hospitals decreased by 98.4%, and that in health centre hospitals by 47.6%. COPD is a cause of repeated hospitalization, but it less and less often leads to long-term hospital treatment nowadays. The number of treatment days required for men has fallen more rapidly than that for women, and both the lengths and numbers of treatment periods have decreased at all levels of hospital, although with a tendency for treatment to be concentrated nowadays in the health centre hospitals. Long-term treatment for COPD has virtually disappeared from the sphere of specialized health care. The trends observed here are attributable to marked changes in the structure of the health service, with more accent being placed on open care, and a decrease in the numbers of male smokers.

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The prognosis of a hospitalized patient for chronic obstructive pulmonary disease (COPD) is poor. The aim of this study was to determine changes in the prognosis for patients entering hospital for the first time on account of COPD in ten years. Data were gathered from the hospital treatment records maintained by the National Research and Development Centre for Welfare and Health in Finland on periods spent in hospital by persons over 44 years of age with a principal diagnosis of COPD over the interval 1972-1994. Two groups of patients were then distinguished separately those first treated in 1980-1984 and those first treated in 1990-1994, and mortality data sought for these persons in the records of Statistics Finland up to the end of 1998. A total of 11,739 men and 3,048 women were found to have been admitted to hospital with a diagnosis of COPD for the first time in the period 1980-1984. The corresponding figures for the interval 1990-1994 were 8,941 men and 3,628 women. The Cox regression model standardized for age showed mortality to have increased in ten years among both the men [Hazard Ratio 1.093 (95% CI 1.055 - 1.133)] and the women [HR 1.138 (95% CI 1.061 - 1.221)]. This worsening of the prognosis was most pronounced in the age group 45-64 years, where the men had an HR of 1.145 (95% CI 1.060 - 1.236) and the women of 1.412 (95% CI 1.208 - 1.650). The prognosis for men and younger women in particular entering hospital for the first time for COPD deteriorated significantly over a period of ten years. This may partly be attributed to the increased frequency of diagnosis and treatment of COPD in outpatient departments and to the reduction in rehabilitation. The apparent more rapid worsening of the prognosis for women relative to men can largely be attributed to their increased smoking.

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The duration of inpatient episodes due to COPD and the factors that affect it have recently been an object of increasing attention, as the aim has been to shorten inpatient periods and thereby to cut health-care costs. All hospital episodes of patients aged over 45 for a primary diagnosis of COPD equal or less than 150 days in duration were drawn from the treatment register maintained by the National Research and Development Centre for Welfare and Health. The lengths of these 152569 inpatient periods were analysed for sex, age and secondary diagnoses by covariance analysis. The mean age of men at the beginning of the hospital episode was 70.6 years and that of women 70.1 years. Men accounted for 76.9% of all inpatient episodes. Covariance analysis ofthe data with age standardised as 70.5 years yielded a mean hospital episode length of 8.9 (95% confidence interval (CI) 8.8-9.0) days. The mean length of hospital episodes without a secondary diagnosis was 7.7 (95% CI 7.6-7.7) days and that with a secondary diagnosis was 10.5 (95% CI 10.5-10.6) days. The longest inpatient episodes were recorded for the patients with secondary diagnoses of pneumonia, 14.7 (95% CI 14.2-15.2) days, and cerebral ischaemia, 14.2 (95% CI 13.5-14.9) days. Concurrent diseases prolonged the hospital episodes of COPD patients. At the beginning of a hospital episode, it is possible to estimate its duration and the need for different treatments based on the patients age and secondary diagnoses.

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The purpose of this paper is to describe seasonal fluctuations in hospitalisation for pneumonia in Finland over the period 1972-1993. Treatment periods with pneumonia as the main or secondary diagnosis were collected from the national hospital discharge register. The seasonality of monthly hospital admissions was analysed using the X11 ARIMA procedure. The population of Finland numbered 5 million during the period concerned, and there were a total of 453,393 pneumonia treatment periods, 17.9% in the age-group under 16 years, 29.6% among working-age persons and 52.5% among persons aged over 64 years. The number was greatest in the total population in December (20.5%) and January (25.1%) and lowest in July (-19.7%) and August (-24.3%). Seasonal fluctuations in pneumonia hospitalisations pointed to the same trend in both the sexes, in that the number increased in winter and decreased in summer. Children's admissions began to increase a month earlier than those of the other age groups, however, in November, while a transient increase in admissions of working age persons in March is attributable to the more extensive use of hospital services by army conscripts. Admissions of persons aged over 64 years fell more slowly from the winter peak than did those of the other segments of the population. The winter peak in hospital admissions for pneumonia can be anticipated administratively by increasing the number of hospital beds and intensifying outpatient care. It may not be necessary to increase health care resources to achieve this, however, as the necessary resources can be obtained through reductions in the summer months. Proper recognition of admission peaks, the points in time at which these regularly occur and the target groups within the population can contribute greatly to health care planning and its economy.

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The effectiveness of simultaneously administered influenza and pneumococcal vaccines vs. influenza vaccine alone in preventing pneumonia, pneumococcal pneumonia and pneumococcal bacteraemia among the elderly was studied. The vaccines were offered to all persons aged 65 years or older (N=43,500) living in 35 administrative districts in Northern Finland. A total of 26,925 persons (62%) decided to participate. Allocation to the vaccination groups took place by year of birth (odd/even). The total follow-up of those vaccinated consisted of 38,037 person years. The incremental effectiveness of the pneumococcal vaccine was -20 (95% CI -50- + 10%) for pneumonia, -20 (95% CI -90- + 20%) for pneumococcal pneumonia and + 60% (95% CI -40- +90%) for pneumococcal bacteraemia. Thus the pneumococcal polysaccharide vaccine did not offer any additional protection from pneumonia among elderly people in Finland although it reduced the incidence of bacteraemia.

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This paper discusses the clinical history of a Finnish person from the area north of the Arctic Circle with childhood-onset bronchiectasis. It covers a period of 30 years and is aimed at analysing the significance of the disease for the use of hospital services. Childhood bronchiectasis is a rare disease nowadays and difficult to diagnose, but it still leads to serious disability in some children, requiring regular hospitalisation. The prognosis for these cases with advancing age is not known.

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The incidence and age distribution of bronchiectasis is at present poorly known. The aim here was to describe the use made of hospital services by bronchiectasis patients in Finland over ten years and to estimate the incidence of this disease. Data on hospital admissions for bronchiectasis were obtained from the register maintained by the National Research and Development Centre for Welfare and Health. Admissions and new cases during the period 1983-1992 were calculated by age and sex in relation to the total population. There were 5,710 admissions for bronchiectasis and 1,928 new cases. The occurrence of cases treated in hospital was 4.9 per million person-years at age 0-14 years, 103.8 at 65 years or over and 38.9 in the total population. The estimated incidence of bronchiectasis is low in Finland, especially in childhood, and efforts aimed at its treatment should now be directed specifically at the elderly population, which continues to exert considerable pressure on even a relatively well developed health service in this respect.

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The aim was to evaluate the differences of mortality among asthma and COPD patients on the basis of the first period of hospitalization of these diseases. A total of 576,916 treatment periods for asthma and COPD between 1972 and 1992 were identified in the discharge register maintained by the National Research and Development Centre for Welfare and Health. Patients aged 50-54 years first treated in hospital in 1977 or later were analysed. There were 6655 new asthma patients of this age, 2727 new COPD patients and 701 new patients in a mixed group (with both diagnoses). Mortality up to the end of 1993 was analysed based on mortality and cause of death data provided by the Central Statistical Office of Finland. Estimated cumulative survival after 10 yr was higher among the asthma patients (83.5% for men and 93.2% for women) and lower among the COPD patients (60.1% and 78.0%) and in the mixed group (62.5% and 74.4%). The main cause of death among the asthmatics was asthma in 12.1% of cases, that among the COPD patients was COPD in 22.1% of cases and that in the mixed group was one or other of these diseases in 39.1% of cases. The prognosis for COPD patients aged 50-54 years requiring hospital treatment is poor. Combination of the data available from the cause of death and hospital discharge registers indicates that obstructive pulmonary diseases may well be of more significance from a public health point of view than the mortality statistics would lead us to believe. The very first hospitalization for COPD calls for a thorough evaluation of the prospects for active treatment and prevention.

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The purpose of this study was to examine possible seasonal variations in relations between hospital treatment periods and in deaths (asthma-related and other) among adult asthmatics. Out of a total of 364,871 asthma-induced hospitalization periods (diagnosis No. 493, International Classification of Diseases) recorded in the hospital discharge register maintained by the National Research and Development Centre for Welfare and Health during 1972-1992, all of those applying to persons aged >24 yrs during 1987-1992 were analysed here. The discharge file was linked to the register of deaths on the basis of the patients' social security numbers in order to analyse all deaths among the same patients during 1987-1993. A total of 81,243 asthma-related treatment periods were analysed. The monthly variation in the number of such periods showed a peak in January (18.2% above the mean number of monthly deaths in the study period) and a trough in July (26.1% below the mean). Of the 7,622 hospitalized asthmatics who died during the period examined here, 1,274 died of obstructive pulmonary diseases, with asthma as the primary cause in 489 cases. The majority of the deaths were caused by cardiovascular diseases. Mortality was highest in January (+14.7%) and lowest in August (-12.3%). The similarity in the seasonal variation observed between the treatment periods and deaths recorded for adult asthmatics may be taken to indicate a genuine need for treatment.

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In view of the conflicting notions of the relationship between bronchiectasis and asthma, we have analysed the use of hospital services by bronchiectasis and asthma patients and evaluated the links between these diseases, employing data from the Finnish Hospital Discharge Register of over 21 million hospitalization periods recorded in 1972-92. We conclude that asthma is common in hospitalized bronchiectasis patients and appears to be consequent upon this disease.

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The incidence of bronchiectasis has probably declined in developed countries in recent years, but no reliable statistical data on this are available. The present paper describes the use made of hospital services by bronchiectatic patients in Finland. Data on a total of 12,539 treatment periods for bronchiectasis that had occurred between 1972 and 1992 were collected from the discharge register maintained by the National Research and Development Centre for Welfare and Health (diagnosis 518 in the International Classification of Diseases up to 1986, and 494 from 1987 onwards). The number of admissions, new occurrences of bronchiectasis and days in hospital were calculated by sex and age in relation to the total population at the end of each year. There were 143 and 87 admissions per million inhabitants in 1972 and 1992, respectively. The admissions, new occurrences and the days in hospital all decreased, at annual rates of 1.3, 4.2 and 5.7%, respectively. Thus, where the number of new occurrences was 50 per million persons in 1977, it was 27 per million in 1992. In summary, bronchiectasis-related hospital treatment declined markedly between 1972 and 1992. Trend is attributed to effective treatment of pulmonary infections and the reduction in tuberculosis.

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AIM: to describe the use of hospital services by Finnish adults aged 65 or over with pneumonia from 1972 to 1993. MATERIAL AND METHODS: the study was based on nation-wide hospital discharge records. Patients in hospital for over 150 days were excluded. The number of persons aged 65 or over was 458,156 in 1972 and 707,341 in 1993. RESULTS: pneumonia caused 237,330 periods of hospital treatment and a total of 3,826,986 hospitalization days in elderly people during the 22-year period. Annual hospital treatment periods increased from 15.5 to 23.9 per 1000 of population aged 65 years or over within this interval. The average annual change in the age-adjusted rate of hospital admissions for pneumonia was 1.45% [95% confidence interval (CI) 1.03 to 1.87] for males and 0.83% (95% CI 0.39 to 1.28) for females. The increase was highest in the oldest male group, those aged 85 years or over. In 1972 the number of hospitalization days recorded was 126,690 (277 per 1000) and in 1993 it was 242,638 (343 per 1000), implying an absolute increase of 91.5%. However, the average annual change in the age-adjusted rate of hospitalization days for pneumonia showed a decrease of 0.62% (95% CI 1.04 to 0.19). CONCLUSION: the recorded increase in the use of hospital services by elderly patients with pneumonia, combined with the current increase in size of the elderly population, suggests that the prevention and treatment of pneumonia in this sector of the population will pose a challenge for the health service in the future.

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The purpose was to examine changes in the numbers of asthma-related hospitalizations among conscripts and possible seasonal fluctuations. Data on treatment periods for asthma among men aged 18-22 years at military hospitals in 1982-1992 were collected from the national hospital discharge register. Monthly numbers of hospitalizations were calculated for each year separately, together with the frequency of such periods per 1000 conscripts. Results. A total of 4894 asthma-related hospitalizations were recorded in 1982-1992, the frequency per 1000 conscripts increasing from 8.5 in 1982 to 27.7 in 1992. Evident seasonal fluctuations were observed in 1982-1989, the peaks being recorded for February (14% above the annual average), July (26%) and November (51%). A change in these seasonal fluctuations was observed in 1990-1992, however. The frequency of asthma-induced hospitalizations among conscripts tripled between 1982 and 1992, evidently indicating a real increase in the number of occurrences. The hospitalization peaks are located at the beginning of military service, a point at which factors tending to aggravate asthma exercise a major impact.

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UNLABELLED: All hospital treatment periods caused by asthma in children under 15 years in Finland during 1972-1992 were examined. The data were obtained from the Hospital Discharge Register, covering all hospitalisations in Finland. A total of 59,624 asthma related treatment periods were recorded. The monthly variation in hospitalisations peaked in May (35.6% above the trend) and in autumn and early winter (41.3% above the trend in October), whereas the monthly variations were low in late winter and in summer. The overall profile of seasonal variation was similar in both sexes, although admissions were lower for boys than for girls in winter and higher in autumn. The average monthly deviation was highest in the age group 0-4 years in May, 42.8% above the trend, and highest in the age group 5-9 years in October, 53.9% above the trend. Closer examination of the seasonal variation gives indirect information on possible trigger factors for acute asthma. CONCLUSION: A clear seasonal variation could be observed in childhood asthma hospital admissions, together with age and sex-related differences in this seasonality. Preventive treatment for asthma should be used effectively in order to avoid acute attacks leading to hospitalisation in children who are allergic to birch pollen and also at times of viral respiratory infections.

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