Abstract
BackgroundCompared to men, women report greater morbidity and make greater use of health-care services. This study examines potential determinants of gender differences in the utilization of health-care services among the elderly.MethodsCross-sectional study covering 3030 subjects, representative of the non-institutionalized Spanish population aged 60 years and over. Potential determinants of gender differences in the utilization of health services were classified into predisposing factors (age and head-of-family status), need factors (lifestyles, chronic diseases, functional status, cognitive deficit and health-related quality of life (HRQL)) and enabling factors (educational level, marital status, head-of-family employment status and social network). Relative differences in the use of each service between women and men were summarized using odds ratios (OR), obtained from logistic regression. The contribution of the variables of interest to the gender differences in the use of such services was evaluated by comparing the OR before and after adjustment for such variables.ResultsAs compared to men, a higher percentage of women visited a medical practitioner (OR: 1.24; 95% confidence limits (CL): 1.07–1.44), received home medical visits (OR: 1.67; 95% CL: 1.34–2.10) and took ≥3 medications (OR: 1.54; 95% CL: 1.34–1.79), but there were no gender differences in hospital admission or influenza vaccination. Adjustment for need or enabling factors led to a reduction in the OR of women compared to men for utilization of a number of services studied. On adjusting for the number of chronic diseases, the OR (95% CL) of women versus men for ingestion of ≥3 medications was 1.24 (1.06–1.45). After adjustment for HRQL, the OR was 1.03 (0.89–1.21) for visits to medical practitioners, 1.24 (0.98–1.58) for home medical visits, 0.71 (0.58–0.87) for hospitalization, and 1.14 (0.97–1.33) for intake of ≥3 medications. After adjustment for the number of chronic diseases and HRQL, the OR of hospitalization among women versus men was 0.68 (0.56–0.84).ConclusionThe factors that best explain the greater utilization of health-care services by elderly women versus men are the number of chronic diseases and HRQL. For equal need, certain inequality was observed in hospital admission, in that it proved less frequent among women.
Highlights
Compared to men, women report greater morbidity and make greater use of health-care services
Women presented with a greater number of chronic diseases, were less frequently independent in instrumental activities of daily living (IADL), had a higher frequency of cognitive deficit, and worse health-related quality of life (HRQL) in terms both of physical and mental components
Spanish women aged 60 years and over visit to medical practitioners, receive home medical visits, and use a high number of medications more frequently than men. This is in part explained by variables associated with the need for health services and by factors enabling their use
Summary
Women report greater morbidity and make greater use of health-care services. Women live longer but, paradoxically, report greater morbidity and disability and make greater use of health-care services at the end of life [1,2,3]. Women tend to use preventive and diagnostic services more frequently, whereas men make greater use of emergency services [4]. Utilization of health services by women and men differs according to the health problem for which care is required. After adjustment for social and economic factors, women visit the medical practitioner more often than men when presenting a mood-anxiety disorder or a substance use-antisocial behaviors disorder, though the magnitude of the association between female gender and medical visit is greater in the case of the mood-anxiety disorder [17]
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