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Juho Pylväläinen,1–3 Kirsi Talala,4 Teemu Murtola,5–7 Kimmo Taari,8 Jani Raitanen,1,9 Teuvo L Tammela,6 Anssi Auvinen1 1Tampere University, Faculty of Social Sciences (Health Sciences), Tampere, Finland; 2Helsinki University, Faculty of Medicine, Department of Diagnostics and Therapeutics, Helsinki, Finland; 3Helsinki University Central Hospital, Medical Imaging Center, Helsinki, Finland; 4Cancer Society of Finland, Finnish Cancer Registry, Mass Screening Registry, Helsinki, Finland; 5Tampere University, Faculty of Medicine and Health Technology, Prostate Cancer Research Center, Tampere, Finland; 6Tampere University Hospital, Department of Urology, Tampere, Finland; 7Seinäjoki Central Hospital, Department of Surgery, Seinäjoki, Finland; 8University of Helsinki and Helsinki University Hospital, Department of Urology, Helsinki, Finland; 9UKK Institute for Health Promotion Research, Tampere, FinlandCorrespondence: Juho PylväläinenHelsinki University Central Hospital, Medical Imaging Center, Haartmaninkatu 3, PO Box 180, 00029, Helsinki, Uusimaa, FinlandTel +358 503239286Email juho.pylvalainen@hus.fiPurpose: To evaluate the performance of Charlson Comorbidity Index (CCI) calculated using hospitalization and medication reimbursement databases in predicting mortality.Patients and methods: Information on hospitalizations was obtained from the national Care Register for Health Care (HILMO) and on medication reimbursements and entitlements for special reimbursements for medications from the Social Insurance Institution for 77,440 men aged 56–71 years at baseline. The subjects were followed up for mortality via Statistics Finland with 20,562 deaths during a 13-year follow-up.Results: Compared to a CCI score of 0, the age-adjusted hazard ratio for all-cause mortality associated with HILMO-based CCI scores of 1, 2 and 3 or more were 2.39 (95% CI 2.29–2.49), 2.96 (95% CI 2.81–3.13) and 6.42 (95% CI 5.95–6.93) at 13 years. The C-statistic was 0.72 at 1, 0.68 at 5 and 0.66 at 13 years, with only minor improvement over age alone (0.10, 0.06 and 0.04 accordingly). Addition of medication data did not improve predictive abilities and medication-based CCI performed poorly on its own.Conclusion: The hospitalization-based CCI, as well as that based on both databases, predicts relative mortality adequately, but its discriminative ability diminishes over time. Conditions related to hospitalizations affect survival more than medications.Keywords: mortality, comorbidity, follow-up studies, hospitalization/statistics and numerical data, drug prescriptions/statistics and numerical data, confounding factors

Background: Socio-economic differences in depressive symptoms are well reported, but there are only few studies concerning changes in these differences over time. The aim of this study was to assess trends in socio-economic differences in self-reported depression over the time period 1979-2002 in Finland.Methods: The data source was a representative repeated cross sectional survey "Health Behaviour and Health among the Finnish Adult Population" (AVTK) linked with socio-economic register data from Statistics Finland, for the period 1979-2002. The age group of 25-64 years was included in this study (N = 71,290; average annual response rate 75%). Outcome measure was a single question of self-reported depression. Socio-economic factors included education, employment status and household income. The main analyses were conducted by multiple logistic regression.Results: The prevalence of self-reported depression fluctuated in both men and women but remained higher in women compared to men over the past 24 years. After adjusting for age, socio-economic differences in self-reported depression were clear in regard to education, employment status and household income over the time period 1979-2002. When all socio-economic factors were mutually adjusted for, the association with self-reported depression remained significant in the unemployed, the retired and in those in the lowest household income categories in both genders. The effect of education on self-reported depression was mediated by the other socio-economic factors. Based on a time trend analysis, the socio-economic differences in self-reported depression remained stable over the time period 1979-2002.Conclusions: Socio-economic inequalities in self-reported depression were confirmed, and they have persisted with approximately the same magnitude over the past 24 years. [ABSTRACT FROM AUTHOR]