Gender differences in the utilization of health-care services among the older adult population of Spain.
BACKGROUND
Compared 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.


METHODS
Cross-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.


RESULTS
As 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 > or = 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 > or = 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 > or = 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).


CONCLUSIONS
The 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.
Redondo-Sendino
Aurea
A
Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain. aurea.redondo@uam.es
Guallar-Castillón
Pilar
P
Banegas
José Ramón
JR
Rodríguez-Artalejo
Fernando
F
D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease / Q000453:epidemiology; D003430:Cross-Sectional Studies; D004363:Drug Utilization; D005191:Family Characteristics; D005194:Family Practice / Q000706:statistics & numerical data; D005260:Female; D015438:Health Behavior; D019538:Health Care Surveys; D006296:Health Services / Q000706:statistics & numerical data*; D006792:House Calls / Q000706:statistics & numerical data; D006801:Humans; D008019:Life Style; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D011788:Quality of Life; D017678:Sex Distribution; D012959:Socioeconomic Factors; D013030:Spain / Q000453:epidemiology