Marital status and health care utilization.
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.
Joung
I M
IM
Department of Public Health, Erasmus University Rotterdam, The Netherlands.
van der Meer
J B
JB
Mackenbach
J P
JP
D000328:Adult; D000368:Aged; D015986:Confounding Factors, Epidemiologic; D004522:Educational Status; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D017533:Marital Status; D008393:Marriage; D008875:Middle Aged; D009426:Netherlands; D012044:Regression Analysis