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0 ± 3.6, mean ± SD number of specialist visits was 2.4 ± 3.4, and 17% were hospitalized in the past 12 months. Negative binomial regressions revealed that the presence of DSI was associated with increased specialist visits (incidence rate ratio = 1.17 [95% confidence interval 1.06-1.28]), whereas it was not associated with GP visits and hospitalization. CONCLUSIONS Even after adjusting for several covariates, individuals with DSI had higher specialist visits than individuals without DSI. As the presence of DSI is associated with an inc