Gender, psychosocial factors and the use of medical services: a longitudinal analysis
Gender, psychosocial factors and the use of medical services: a longitudinal analysis
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DOI：
10.1016/s0277-9536(98)00440-7
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发表时间：
1999-05-01
影响因子：
5.4
通讯作者：
Pope, CR
中科院分区：
文献类型：
--
作者：
Green, CA;Pope, CR
许多研究人员报告了报告的症状，发病率，死亡率和医疗保健利用水平的性别差异，但关于这些差异的根本原因的争论仍在继续。有些人认为，妇女使用医疗服务较多是因为她们对症状更敏感，对健康更感兴趣，而另一些人则认为，妇女使用医疗服务较多是因为妇女的发病率高于男子。迄今为止，这些问题尚未进行前瞻性研究。本研究利用1970-1971年进行的家庭访谈调查资料，结合22年的卫生服务利用记录，探讨了性别、自报健康状况、精神和身体症状水平、健康知识、患病行为以及健康关注和兴趣对长期卫生服务利用的影响。在控制了上述因素后，在22年的研究期间，女性仍然是较高利用率的独立预测因素，在最初的访谈中测量的心理社会和健康因素预测了19-22年后的服务使用。控制因素确定为性别相关的差异，在医疗保健利用的可能原因，性别仍然是一个重要的预测因素的医疗保健使用之前和之后删除性别特异性利用。此外，态度和行为因素的一致预测能力，结合健康知识不能预测利用率的发现，表明帮助患者评估其服务需求的努力应该针对随性别而变化的态度和行为因素，而不仅仅是健康相关知识。(C)1999 Elsevier Science Ltd.保留所有权利。
Many researchers have reported gender differences in levels of reported symptoms, morbidity, mortality and medical care utilization, but the debate continues about the underlying causes of these differences. Some have argued that women use more medical services because they are more sensitive to symptoms and interested in health, while others believe that women's greater service utilization arises from the fact that women experience more morbidities than do men. To date, these questions have not been studied prospectively. Using data from a household interview survey carried out in 1970-1971 and linked to 22 years of health services utilization records, we explored the effects of gender, self-reported health status, mental and physical symptom levels, health knowledge, illness behaviors and health concerns and interest on the long-term use of health services. After controlling for the aforementioned factors, female gender remained an independent predictor of higher utilization over the 22-year period studied, and psychosocial and health factors measured at the initial interview predicted service use even 19-22 years later. Controlling for factors identified as likely causes of gender-related differences in healthcare utilization, gender remains an important predictor of medical care use before and after removing sex-specific utilization. In addition, the consistent predictive ability of attitudinal and behavioral factors, combined with the finding that health knowledge did not predict utilization, indicates that efforts to help patients assess their service needs should target the attitudinal and behavioral factors that vary with gender, rather than health-related knowledge alone. (C) 1999 Elsevier Science Ltd. All rights reserved.