Health care utilisation following childhood acute lymphoblastic leukaemia: a population-based matched cohort study
Karen Schow Jensen1, Birgitte Klug Albertsen2, Henrik Schrøder2
1Department of Paediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark kascje@rm.dk.
Insights
Childhood acute lymphoblastic leukaemia (ALL) survivors utilize more healthcare services than the general population, with usage decreasing over 15 years post-treatment. This highlights evolving health needs for ALL survivors.
Area of Science:
- Pediatric Oncology
- Health Services Research
- Epidemiology
Background:
- Childhood acute lymphoblastic leukemia (ALL) survival rates have significantly improved.
- Long-term morbidity in ALL survivors necessitates understanding their healthcare utilization.
- Secondary health conditions pose a growing burden on survivors.
Purpose of the Study:
- To compare primary and secondary healthcare use in childhood ALL survivors versus matched controls up to 15 years post-treatment.
- To analyze changes in healthcare seeking behavior over time in ALL survivors.
- To inform the organization of follow-up care for childhood cancer survivors.
Main Methods:
- Population-based matched cohort study using Danish nationwide registries.
- Inclusion of 675 childhood ALL survivors (diagnosed 1994-2015) and 6750 matched controls.
- Analysis of yearly healthcare consultations (general practice, hospital outpatient/inpatient) using incidence rate ratios (IRRs).
Main Results:
- ALL survivors showed higher yearly general practice contacts (IRR 1.85 initially, decreasing to 1.16 at 15 years).
- ALL survivors had substantially higher yearly hospital contacts (IRR 31.50 initially, decreasing to 2.42 at 15 years).
- Healthcare utilization decreased over 15 years, with no gender or age impact, and no calendar time differences.
Conclusions:
- Childhood ALL survivors consistently utilize more healthcare services across all sectors compared to the general population.
- The observed decrease in healthcare use over 15 years reflects evolving survivor needs.
- Findings support the need for organized, integrated follow-up programs for childhood ALL survivors.
Objectives:
Survival among children diagnosed with acute lymphoblastic leukaemia (ALL) has increased considerably. However, morbidity in survivors constitutes a potential increasing burden not limited to secondary health care. Our objectives were to compare health care utilisation, including both primary and secondary health care, between childhood ALL survivors and matched references up to 15 years after curative treatment. Moreover, to increase knowledge on survivors' health service seeking behaviour as time from treatment elapsed.
Design And Setting:
A Danish population-based matched cohort study linking multiple nationwide registries.
Participants:
675 cases, diagnosed with childhood (1.0-17.9 years) ALL between 1994 and 2015, and 6750 matched references sampled randomly from the source population (matched on age, gender and geographical region).
Primary Outcome Measures:
Repeated consultations in general practice and hospital (outpatient and inpatient) estimated as yearly rates from 2.5 years after diagnosis and onwards. We compared cases and references with yearly incidence rate ratios (IRRs) from negative binomial regression models.
Results:
Survivors of childhood ALL had a mean number of yearly daytime contacts in general practice of 4.75 (95% CI 4.41 to 5.11) the first year, corresponding to an IRR of 1.85 (95% CI 1.71 to 2.00); decreasing to 1.16 (1.01 to 1.34) after 15 years, and without significant impact of gender (p=0.894) or age (p=0.399). For hospital contacts, ALL survivors had a mean number of yearly contacts of 14.21 (13.38-15.08) the first year, corresponding to an IRR of 31.50 (28.29-35.07); decreasing to 2.42 (1.59-3.68) after 15 years. No differences were found across calendar time.
Conclusions:
ALL survivors used significantly more health care services across sectors than the reference population. Decreasing use over 15 years illustrated the dynamics of health care needs; this knowledge may inform the future organisation of integrated follow-up programmes.
Trial Registration Number:
NCT03985826.
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