To describe pregnancy complications, mode of delivery and neonatal outcomes by mother's residence.
Register-based cohort study.
Geographical regions of Iceland.
Live singleton births from 1 January 2000 to 31 December 2009 (n = 40 982) and stillbirths =22 weeks or weighing =500 g (n = 145).
Logistic regression was used to explore differences in outcomes by area of residence while controlling for potential confounders. Maternal residence was classified according to distance from Capital Area and availability of local health services.
Preterm birth, low birthweight, perinatal death, gestational diabetes and hypertension.
Of the 40 982 infants of the study population 26 255 (64.1%) were born to mothers residing in the Capital Area and 14 727 (35.9%) to mothers living outside the Capital Area. Infants outside the Capital Area were more likely to have been delivered by cesarean section (adjusted odds ratio 1.28; 95% CI 1.21-1.36). A lower prevalence of gestational diabetes (adjusted odds ratio 0.68; 95% CI 0.59-0.78), hypertension (adjusted odds ratio 0.82; 95% CI 0.71-0.94) as well as congenital malformations (adjusted odds ratio 0.55; 95% CI 0.48-0.63) was observed outside the Capital Area. We observed neither differences in mean birthweight, gestation length nor rate of preterm birth or low birthweight across Capital Area and non-Capital Area. The odds of perinatal deaths were significantly higher (adjusted odds ratio 1.87; 95% CI 1.18-2.95) outside the Capital Area in the second half of the study period.
Lower prevalence of gestational diabetes and hypertension outside the Capital Area may be an indication of underreporting and/or lower diagnostic activity.
The aim of this study was to explore differences in self-rated health and physician-diagnosed disease across geographical regions in Iceland to better understand regional requirements for health services.
Data on self-rated health and diagnosed disease from a 2007 national health survey (n=5909; response rate 60.3%) across geographic regions were analysed. Area of residence was classified according to distance from the Capital Area (CA) and availability of local health services. We used regression models to calculate crude and multivariable adjusted odds ratios (aOR) and corresponding 95% confidence intervals (95% CI) of self-rated health and diagnosed diseases by area of residence. Models were adjusted for age, gender, education, civil status, and income.
Residents in rural areas with no local health service supply rated their physical health worse than residents of areas with diverse supply of specialised services (aOR 1.40, 95% CI 1.21-1.61). Residents outside the CA rate both their physical (aOR 1.35, 95% CI 1.23-1.50) and mental (aOR 1.17, 95% CI 1.06-1.30) health worse than residents in the CA. In contrast, we observed a lower prevalence of several diagnosed chronic diseases, including cancers (aOR 0.78, 95% CI 0.60-0.99) and cardiovascular disease (aOR 0.77, 95% CI 0.62-0.95) outside the CA.
These findings from a national survey of almost 6000 Icelanders indicate that self-rated health is related to regional healthcare supply. The findings have implications for national planning of health services aiming at equality both in health and access to health services.
Pharmacoepidemiology is a rapidly growing discipline that is useful in studies on effects and adverse effects of drugs. During past years and decades databases have been built in Iceland that are becoming powerful tools for this kind of research. The databases are, however only useful for pharmacoepidemiological research if they include personal identification and can be merged. The personal identification should be without time limits because in many cases we are interested in what happened years or decades ago. The prescriptions database was started in 2002 and has dramatically changed the possibilities for pharmacoepidemiological studies in Iceland. The main aim of this review is to give an overview of the existing databases in Iceland and to encourage research in this important field.