title: Municipal variation in health and social service use in the last 2 years of life among old people.
abstract: OBJECTIVE
  To describe and analyse municipal differences in health and social service use among old people in the last 2 years of life.
  
  
  METHODS
  The data were derived from national registers. All those who died in 2002 or 2003 at the age of ≥ 70 years were included except those who lived in very small municipalities. The services included were different types of hospitals, long-term care, and home care. The variation in service use was described by coefficients of variation (CV). To analyse local differences, three-level (individual, municipal, and regional) binary logistic and Poisson regression analyses were performed.
  
  
  RESULTS
  A total of 67,027 decedents from 315 municipalities in 20 hospital districts were included. There was considerable variation in service use between residents of different municipalities, especially in the types of hospital used. Of the individual-level variables age and use of other services were associated (p < 0.05) with use of all services. Of the municipal-level variables, indicators describing the service pattern in the municipality were associated with use of all services and average age of decedents with most of the services. The presence of a university hospital in the hospital district increased the probability of using university and general hospitals, but among the users increased days in university hospital and decreased days in general hospital.
  
  
  CONCLUSIONS
  Considerable differences between municipalities exist, but these cannot be exhaustively explained. Behind the differences are probably factors which are difficult to describe and quantify, such as historical developments and political realities.
authors.affiliation: School of Health Sciences, University of Tampere, Finland. leena.forma@uta.fi
authors.forename: Leena
authors.initials: L
authors.lastname: Forma
authors.forename: Marja
authors.initials: M
authors.lastname: Jylhä
authors.forename: Mari
authors.initials: M
authors.lastname: Aaltonen
authors.forename: Jani
authors.initials: J
authors.lastname: Raitanen
authors.forename: Pekka
authors.initials: P
authors.lastname: Rissanen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003153:Community Health Services / Q000706:statistics & numerical data*; D005260:Female; D005387:Finland; D005851:Geriatric Nursing / Q000706:statistics & numerical data; D017048:Health Care Costs; D006299:Health Services for the Aged / Q000191:economics / Q000706:statistics & numerical data*; D006699:Home Care Services / Q000706:statistics & numerical data*; D006707:Homes for the Aged / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008134:Long-Term Care / Q000706:statistics & numerical data; D008297:Male; D012042:Registries; D012946:Social Welfare / Q000706:statistics & numerical data