Healthcare Use in the Five Years Before a First Infertility Diagnosis: A Danish Register-Based Case-Control Study in the CROSS-TRACKS Cohort

Ninna Hinchely Ebdrup; Anders Hammerich Riis; Cecilia Høst Ramlau-Hansen; Bjørn Bay; Julie Lyngsø; Dorte Rytter; Marianne Johansson Jørgensen; Ulla Breth Knudsen

doi:10.2147/CLEP.S360292

Healthcare Use in the Five Years Before a First Infertility Diagnosis: A Danish Register-Based Case-Control Study in the CROSS-TRACKS Cohort

Clin Epidemiol. 2022 May 11:14:677-688. doi: 10.2147/CLEP.S360292. eCollection 2022.

Authors

Ninna Hinchely Ebdrup^{1

2

3}, Anders Hammerich Riis^{4

5}, Cecilia Høst Ramlau-Hansen², Bjørn Bay^{1

6}, Julie Lyngsø⁷, Dorte Rytter², Marianne Johansson Jørgensen⁴, Ulla Breth Knudsen^{1

3}

Affiliations

¹ Department of Obstetrics and Gynecology, Fertility Clinic, Horsens Regional Hospital, Horsens, Denmark.
² Department of Public Health, Aarhus University, Aarhus, Denmark.
³ Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
⁴ Department of Research, Regional Hospital Horsens, Horsens, Denmark.
⁵ Enversion A/S, Aarhus, Denmark.
⁶ Maigaard Fertility Clinic, Aarhus, Denmark.
⁷ Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark.

Abstract

Purpose: Infertility may affect somatic and mental health later in life. Nevertheless, health status before diagnosed infertility is sparsely studied in women. We aimed to describe healthcare use in primary and secondary care before a first infertility diagnosis and compare use between cases and controls.

Materials and methods: The case-control study was based on register data and used incidence density sampling. From the CROSS-TRACKS Cohort, we included women residing in the Horsens area in Denmark in 2012-2018 (n = 54,175). Eligible women were aged 18-40 years, nulliparous, and living in heterosexual relationships. Cases were women with a first infertility diagnosis in the Danish National Patient Registry (index date). Five controls were matched on age, birth year, and calendar time. Through linkage to Danish national health registries, we identified general practitioner (GP) attendance, paraclinical examinations, hospital contacts, diagnoses, and redeemed prescriptions. Healthcare use from one year to five years before index date was compared with conditional logistic regression.

Results: We identified 711 cases and 3555 controls. At one year before index date, cases consulted their GP (odds ratio (OR) = 5.2, 95% confidence interval (CI): 3.2, 8.3) and visited hospital (OR = 1.2, 95% CI: 1.0, 1.4) and redeemed prescriptions (OR = 2.3 95% CI: 1.9, 2.7) more often compared to controls. Cases more often had blood and hemoglobin tests performed, redeemed more drugs related to genitourinary and hormonal diseases, and were more often diagnosed with endocrine and genitourinary diseases in the year before a first infertility diagnosis compared to controls. Cases and controls had comparable healthcare use from five years to one year before a first infertility diagnosis.

Conclusion: Cases and controls had similar healthcare use from five years to one year before a first infertility diagnosis. However, cases had a higher healthcare use in the year preceding a first infertility diagnosis compared to controls.

Keywords: behavior; fertility; health status; incidence density; medically assisted reproduction; preconception health.

Grants and funding

The study was supported by grants from Horsens Regional Hospital, the Health Research Foundation of the Central Denmark Region, Aarhus University, Aase and Ejnar Danielsen’s Foundation, Merck and Ferring.