Risk factors of post-discharge under-five mortality among Danish children 1997-2016: A register-based study

Autoři: Andreas Jensen aff001;  Per Kragh Andersen aff002;  John Sahl Andersen aff003;  Gorm Greisen aff004;  Lone Graff Stensballe aff001
Působiště autorů: Department of Paediatrics and Adolescent Medicine, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark aff001;  Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark aff002;  Section of General Practice and Research Unit for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark aff003;  Department of Neonatology, Rigshospitalet, Copenhagen University Hospital and the University of Copenhagen, Copenhagen, Denmark aff004
Vyšlo v časopise: PLoS ONE 14(12)
Kategorie: Research Article
prolekare.web.journal.doi_sk: 10.1371/journal.pone.0226045



Estimating associations between somatic and socioeconomic risk factors and post-discharge under-five mortality.


Register-based national cohort study using multiple Cox regression.


The population of 1,263,795 Danish children live-born 1997–2016 who survived until date of first discharge to the home after birth was followed from that date until death, emigration, 5 years of age or 31 December 2016.

Main outcome measures

(A) Mortality hazard ratios (HRs) among all children, (B) mortality HRs among children without severe chronic disease, and (C) mortality HRs among children without severe chronic disease or asthma.

Main results

In the total population (1,947 deaths) severe chronic disease was associated with mortality HR = 15.28 (95% CI: 13.77–16.95). In children without severe chronic-disease (719 deaths) other somatic risk factors were immature birth HR = 3.40 (1.92–6.02), maternal smoking HR = 1.84 (1.55–2.18) and low birth weight HR = 1.74 (1.21–2.51). Socioeconomic risk factors for mortality included: maternal age < 25 years HR = 1.91 (1.38–2.64) compared to > 35 years (similar for 30–35 years and 25–29 years), lowest vs. highest family income tertile HR = 1.76 (1.23–2.51), not living with both parents HR = 1.63 (1.25–2.13), maternal unemployment HR = 1.54 (1.12–2.12), presence of siblings HR = 1.44 (1.20–1.71) and secondary vs. tertiary parental education HR = 1.33 (1.07–1.65) for fathers and HR = 1.23 (1.01–1.52) for mothers. Factors not found to be associated with child mortality in this population included presence of asthma HR = 1.29 (0.83–1.98) and non-Danish ethnicity HR = 0.98 (0.70–1.37).


Childhood death after discharge to the home after birth and before 5 years of age is a very rare event in Denmark. This ‘post-discharge’ mortality was heavily associated with severe chronic disease. In children without severe chronic disease, immature birth, maternal smoking and certain socioeconomic characteristics were noticeable risk factors. Mortality may possibly be decreased by focusing on vulnerable groups.

Klíčová slova:

Death rates – Socioeconomic aspects of health – Birth weight – Children – Child health – Medical risk factors – Asthma – Danish people


1. Yu Y, Qin G, Cnattingius S, et al. Mortality in children aged 0–9 years: A nationwide cohort study from three nordic countries. PLoS One. 2016;11(1).

2. Arntzen A, Samuelsen SO, Bakketeig LS, et al. Socioeconomic status and risk of infant death. A population-based study of trends in Norway, 1967–1998. IntJEpidemiol. 2004 Apr;33(0300–5771 (Print)):279–88.

3. Bilsteen JF, Andresen JB, Mortensen LH, et al. Educational disparities in perinatal health in Denmark in the first decade of the 21st century: a register-based cohort study. BMJ Open. 2018;8(11):e023531. doi: 10.1136/bmjopen-2018-023531 30413512

4. Arntzen A, Andersen AMN. Social determinants for infant mortality in the Nordic countries, 1980–2001. Scand J Public Health. 2004;32(5):381–9. doi: 10.1080/14034940410029450 15513672

5. Zylbersztejn A, Gilbert R, Hjern A, et al. How can we make international comparisons of infant mortality in high income countries based on aggregate data more relevant to policy? BMC Pregnancy Childbirth. 2017;17(1).

6. Zylbersztejn A, Gilbert R, Hjern A, et al. Child mortality in England compared with Sweden: a birth cohort study. Lancet. 2018;

7. Brownell M, Enns J. Reducing child mortality in high-income countries: where to from here? Lancet. 2018;391(10134):1968–9. doi: 10.1016/S0140-6736(18)30938-3 29731174

8. Bremberg SG. The rate of country-level improvements of the infant mortality rate is mainly determined by previous history. Eur J Public Health. 2016;26(4):597–601. doi: 10.1093/eurpub/ckw059 27132275

9. Henriksen L, Simonsen J, Haerskjold A, et al. Incidence rates of atopic dermatitis, asthma, and allergic rhinoconjunctivitis in Danish and Swedish children. J Allergy Clin Immunol. 2015;136(2):360–6.e2. doi: 10.1016/j.jaci.2015.02.003 25828267

10. Schmidt M, Pedersen L, Sørensen HT. The Danish Civil Registration System as a tool in epidemiology. Vol. 29, European Journal of Epidemiology. 2014. p. 541–9. doi: 10.1007/s10654-014-9930-3 24965263

11. Helweg-Larsen K. The Danish Register of Causes of Death. ScandJPublic Heal. 2011 Jul;39(1403–4948 (Linking)):26–9.

12. Bliddal M, Broe A, Pottegård A, et al. The Danish Medical Birth Register. Vol. 33, European Journal of Epidemiology. 2018. p. 27–36. doi: 10.1007/s10654-018-0356-1 29349587

13. Schmidt M, Schmidt SAJ, Sandegaard JL, et al. The Danish National patient registry: A review of content, data quality, and research potential. Vol. 7, Clinical Epidemiology. 2015. p. 449–90. doi: 10.2147/CLEP.S91125 26604824

14. Wallach Kildemoes H, Toft Sørensen H, Hallas J. The Danish national prescription registry. Scand J Public Health. 2011;39(7):38–41.

15. Thygesen LC, Daasnes C, Thaulow I, et al. Introduction to Danish (nationwide) registers on health and social issues: Structure, access, legislation, and archiving. Scand J Public Health. 2011;39(7):12–6.

16. Vanderweele TJ, Shpitser I. A new criterion for confounder selection. Biometrics. 2011;67(4):1406–13. doi: 10.1111/j.1541-0420.2011.01619.x 21627630

17. Talge NM, Mudd LM, Sikorskii A, et al. United States Birth Weight Reference Corrected For Implausible Gestational Age Estimates. Pediatrics [Internet]. 2014;133(5):844–53. Available from: http://pediatrics.aappublications.org/cgi/doi/10.1542/peds.2013-3285 24777216

18. Kristensen K, Hjuler T, Ravn H, et al. Chronic diseases, chromosomal abnormalities, and congenital malformations as risk factors for respiratory syncytial virus hospitalization: a population-based cohort study. Clin Infect Dis. 2012;54(6):810–7. doi: 10.1093/cid/cir928 22247121

19. Pottegård A, Schmidt SAJ, Wallach-Kildemoes H, et al. Data resource profile: The Danish national prescription registry. Int J Epidemiol. 2017;46(3):798. doi: 10.1093/ije/dyw213 27789670

20. Johannesdottir SA, Horváth-Puhó E, Ehrenstein V, et al. Existing data sources for clinical epidemiology: The Danish National database of reimbursed prescriptions. Clin Epidemiol. 2012;4(1):303–13.

21. Hardelid P, Dattani N, Gilbert R. Estimating the prevalence of chronic conditions in children who die in England, Scotland and Wales: A data linkage cohort study. BMJ Open. 2014;4(8).

22. Erdmann F, Winther JF, Dalton SO, et al. Survival From Childhood Hematological Malignancies in Denmark: Is Survival Related to Family Characteristics? Pediatr Blood Cancer. 2016;63(6):1096–104. doi: 10.1002/pbc.25950 26937602

23. Vissing NH, Chawes BL, Rasmussen MA, et al. Epidemiology and Risk Factors of Infection in Early Childhood. Pediatrics. 2018;141(6):e20170933. doi: 10.1542/peds.2017-0933 29794229

24. Simony SB, Lund LW, Erdmann F, et al. Effect of socioeconomic position on survival after childhood cancer in Denmark. Acta Oncol (Madr). 2016;55(6):742–50.

25. Stensballe LG, Klansø L, Jensen A, et al. The validity of register data to identify children with atopic dermatitis, asthma or allergic rhinoconjunctivitis. Pediatr Allergy Immunol. 2017;28(6):535–42. doi: 10.1111/pai.12743 28632331

Článok vyšiel v časopise


2019 Číslo 12