MARITAL-STATUS AND HEALTH-CARE UTILIZATION
MARITAL-STATUS AND HEALTH-CARE UTILIZATION
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DOI：
10.1093/ije/24.3.569
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发表时间：
1995-06-01
影响因子：
7.7
通讯作者：
MACKENBACH, JP
中科院分区：
文献类型：
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作者：
JOUNG, IMA;VANDERMEER, JBW;MACKENBACH, JP
背景一些研究报告了婚姻状况对医疗保健利用的差异，但通常只控制年龄和性别。我们的研究旨在回答以下问题：1）由于年龄和性别以外的社会人口变量的混淆，婚姻状况在医疗保健利用方面存在多大程度的差异？2）这些差异在多大程度上是由于婚姻状况导致的健康状况差异？方法.在分析中，我们使用了卫生服务利用的社会经济差异纵向研究的基线数据。我们的研究人群包括来自荷兰的2662人，年龄在25-74岁之间。患有糖尿病、慢性非特异性肺病、心脏病和背部疾病的人比例过高。我们的措施，卫生保健利用的全科医生咨询，专家咨询，住院和处方药的使用。采用多元Logistic回归模型计算婚姻状况对医疗保健利用的优势比（OR），控制社会人口学变量年龄、性别、教育水平、城市化程度、宗教信仰和出生国（问题1），以及一些健康指标（问题2）。我们发现，教育水平是一个重要的混淆因素之间的关系，医疗保健利用和婚姻状况。此外，健康状况的差异在很大程度上解释了丧偶和离婚者利用保健服务较多的原因，但未结过婚者利用保健服务较少的原因。在控制混杂因素和健康状况后，婚姻状况对医疗保健利用的影响仍存在无法解释的差异：例如，离婚者比已婚者更频繁地住院（OR = 1.53，95%CI：1.03-2.22）。有不同的医疗保健利用的婚姻状况，这不是由于其他社会人口变量或健康状况的差异混淆。有必要进一步调查这些差异，并可能受益于纳入社会心理变量。今后的分析也应包括生活安排。
Background. Several studies have reported differences in health care utilization by marital status, but usually only controlling for age and sex. Our study aimed at answering the questions: 1) To what extent are differences in health care utilization by marital status due to confounding by socio-demographic variables other than age and sex? and 2) To what extent are these differences due to differences in health status by marital status?Methods. For the analyses we used the baseline data from the Longitudinal Study on Socio-Economic Differences in the Utilization of Health Services. Our study population consisted of 2662 people from the Netherlands, aged 25-74 years. People with diabetes mellitus, chronic non-specific lung diseases, heart conditions and back complaints were overrepresented. Our measures for health care utilization were general practitioner consultation, specialist consultation, hospital admission and use of prescription medicines. Multiple logistic regression models were used to calculate odds ratios (OR) for health care utilization by marital status, controlling for the socio-demographic variables age, sex, educational level, degree of urbanization, religion and country of birth (question 1), and a number of health indicators (question 2).Results. We found that educational level is an important confounder of the relationship between health care utilization and marital status. in addition differences in health status to a considerable extent explain the higher utilization of health services of widowed and divorced people, but not the lower utilization of the never married. After control for confounding and health status there still were unexplained differences in health care utilization by marital status: e.g. the divorced were more frequently hospitalized (OR = 1.53, 95% CI : 1.03-2.22) than married people.Conclusions. There are differences in health care utilization by marital status which are not due to confounding by other socio-demographic variables or differences in health status. Further investigation of these differences is necessary, and is likely to benefit from inclusion of socio-psychological variables. Living arrangements should also be included in these future analyses.