Clinical Epidemiology (Jul 2018)
Health care use before a diagnosis of primary intracranial tumor: a Danish nationwide register study
Abstract
Charlotte Nygaard,1 Henry Jensen,1 Jakob Christensen,2,3 Peter Vedsted1,4 1Research Centre for Cancer Diagnosis in Primary Care (CaP), Research Unit for General Practice & Section for General Medicine, Department of Public Health, Aarhus University, Aarhus, Denmark; 2Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; 3Department of Neurology, Aarhus University Hospital, Aarhus, Denmark; 4Department of Clinical Medicine, Aarhus University & Diagnostic Center, University Research Clinic for Innovative Patient Pathways, Silkeborg Regional Hospital, Silkeborg, Denmark Introduction: Detailed knowledge of prediagnostic health care use among patients with primary intracranial tumors is sparse. We aimed to investigate the health care use among adults during the 2 years preceding a diagnosis of a benign or malignant primary intracranial tumor in Denmark. Methods: We conducted a population-based matched cohort study using historical data from Danish nationwide registries, including all patients aged 30–90 years diagnosed with a first-time primary intracranial tumor from January 1, 2009 to December 31, 2014, and with no prior cancer diagnosis (n=5,926). For each patient, ten comparison subjects were identified using density sampling. We analyzed differences in the frequency and timing of health care use within general practice, physiotherapy, radiology, ear–nose–throat, ophthalmology, neurology, and psychiatry. Odds ratios of having multiple contacts were calculated using a conditional logistical regression model. Monthly incidence rate ratios were estimated using a negative binomial regression model. Results: Of all patients, 62% had a benign tumor. Patients with benign tumors were more likely to have multiple consultations with health care providers in the period 2–12 months prior to diagnosis and to have increased rates of consultations 1–24 months prior to diagnosis, depending on health service. Conclusion: Patients diagnosed with a benign or a malignant primary intracranial tumor use the health care services differently. Increased health care use is seen within relatively close proximity to the diagnosis for patients with malignant tumors. However, patients with benign tumors have increased health care use from up to 2 years prior to diagnosis; this suggests a window of opportunity for earlier diagnosis. Keywords: general practice, diagnosis, brain neoplasms, health care services, Denmark
