Gender-based structural models of health care costs: alcohol use, physical health, mental health, and functioning.
Gender-based structural models of health care costs: alcohol use, physical health, mental health, and functioning.
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发表时间：
2004-09
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通讯作者：
Carla A Green;M. Polen;N. Perrin;M. Leo;F. Lynch;D. Rush
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作者：
Carla A Green;M. Polen;N. Perrin;M. Leo;F. Lynch;D. Rush
大多数卫生服务使用或成本模型包括性别作为协变量，在分析中结合男性和女性的数据。这一策略可能会掩盖造成男女不同保健使用的基本过程的差异，特别是在检查影响保健使用和性别差异的因素（如饮酒和抑郁症）时。目的研究饮酒、身心健康和功能以及医疗保健费用之间关系的性别差异。方法：研究背景是Kaiser Permanente Northwest，这是一家大型非营利组织，为美国西北部的俄勒冈州和华盛顿西南部提供服务。在1989-1993年期间（n = 5 669），收集了随机抽样的健康计划成员的初级（调查）和二级（健康计划服务使用记录;病历审查诊断）数据。健康计划的服务使用的行政记录被用来估计医疗保健费用。预测医疗保健费用的性别特异性潜在结构模型是使用自我报告的心理健康，身体健康，功能，饮酒量以及前一年基于抑郁症和酒精问题诊断的健康计划记录创建的。结果：饮酒量和先前的酒精问题与医疗保健费用直接相关，尽管方向相反，男性和女性。酒精消费与成本呈负相关，而先前的酒精问题预测更高的成本。通过饮酒间接影响身体健康与医疗费用的关系存在性别差异。先前的抑郁症对增加医疗保健费用有直接影响，这种关系对男性比女性更强。心理健康症状对男性和女性的作用相似。在调查时，更好的心理健康与减少饮酒或饮酒的可能性有关，但对以后的成本没有直接影响。精神健康的间接影响是通过饮酒发现的。结论：性别在医疗保健总成本的潜在因素中起着重要作用，这些关系中的性别差异在饮酒者中更为常见。对于两种性别，酒精使用预测较低的医疗保健费用在这个轻至中度饮酒人群，虽然酒精问题的先前诊断预测较高的成本。抑郁症诊断与较高的医疗保健费用之间的直接关系在男性中更强。
BACKGROUND Most models of health services use or costs include gender as a covariate, combining data for men and women in analyses. This strategy may obscure differences in underlying processes producing differential health care use by men and women, particularly in examinations of factors that affect health care use and differ by gender (e.g. alcohol consumption and depression). AIMS To examine gender differences in the relationships between alcohol consumption, physical and mental health and functioning, and costs of health care. METHODS The setting was Kaiser Permanente Northwest, a large non-profit group practice model HMO serving northwest Oregon and southwest Washington in the northwest United States. Primary (survey) and secondary (health plan records of service use; diagnoses from medical chart review) data were collected for random samples of health plan members in the period 1989-1993 (n = 5,669). Health plan administrative records of service use were used to estimate health care costs. Gender-specific latent structure models predicting health care costs were created using self-reported mental health, physical health, functioning, alcohol consumption, and prior-year health plan record-based diagnoses of depression and alcohol problems. RESULTS Alcohol consumption and prior alcohol problems were directly related to health care costs, although in opposite directions, for both men and women. Alcohol consumption was negatively associated with costs, while prior alcohol problems predicted higher costs. Gender differences existed in the relationship between physical health and health care costs indirectly via drinking status. Prior depression had direct effects on increased health care costs, and this relationship was stronger for men than for women. The roles played by mental health symptoms were similar for men and women. Better mental health at the time of the survey was associated with reduced alcohol consumption or likelihood of consuming alcohol, but had no direct effects on later costs. Indirect effects of mental health were found via alcohol consumption. CONCLUSIONS Gender plays an important role in the factors underlying total costs of health care, and gender differences in these relationships appear more common among those who consume alcohol. For both genders, alcohol use predicts lower health care costs in this light-to-moderate drinking population, although prior diagnoses of alcohol problems predict higher costs. The direct relationship between depression diagnosis and higher health care costs is stronger among men.