title: Determinants related to gender differences in general practice utilization: Danish Diet, Cancer and Health Cohort.
abstract: OBJECTIVE
  This study aims to describe the determinants related to gender differences in the GP utilization in Danish population aged 50-65 years.
  
  
  METHODS
  Cohort-based cross-sectional study.
  
  
  METHODS
  Danish general practice.
  
  
  METHODS
  Totally, 54,849 participants of the Danish Diet, Cancer and Health cohort (50-65 years).
  
  
  METHODS
  The sum of cohort members' face-to-face consultations with general practitioner (GP) at the cohort baseline year (1993-1997). We obtained data on GP visits from the Danish National Health Service Register at the cohort baseline (1993-1997), when information on lifestyle (smoking, body mass index (BMI), alcohol use, physical activity), medical conditions (somatic and mental), employment, education, gravidity, and hormone therapy (HT) use was collected by questionnaire.
  
  
  RESULTS
  Women had on average 4.1 and men 2.8 consultations per year. In a crude model, women had 47% higher rate of GP visits than men (incidence rate ratio: 1.47; 95% Confidence Interval: 1.45-1.50), which remained unchanged after adjustment for lifestyle, socio-demographic and medical factors, but attenuated to 18% (1.18; 1.13-1.24) after adjustment for female factors (gravidity and post-menopausal HT. In a fully adjusted model, subjects with hypertension (1.63; 1.59-1.67), mental illness (1.63; 1.61-1.66), diabetes (1.56; 1.47-1.65), angina pectoris (1.28; 1.21-1.34), and unemployed persons (1.19; 1.18-1.21) had highest rates of GP visits.
  
  
  CONCLUSIONS
  Gravidity and HT use explain a large proportion, but not all of the gender difference in GP utilization. Medical conditions (somatic and mental) and unemployment are the main determinants of GP utilization in men and women, while lifestyle has minor effect. Key points Female gender remained a dominant determinant of GP utilization, after adjustment for lifestyle, socio-demography, medical and gender specific factors, with females consulting their GP 18% more often than males. Female reproductive factors (use of postmenopausal hormone therapy and gravidity) explained a large proportion of the gender variation in use of GP. Strongest determinants for GP use among Danish adults aged 50-65 years were the presence of medical conditions (somatic and mental) and unemployment, while lifestyle factors (e.g., body mass index, alcohol consumption and smoking) had minor effect.
authors.affiliation: a Centre for Epidemiology and Screening, Department of Public Health , University of Copenhagen , Copenhagen , Denmark ;
authors.forename: Jeanette Therming
authors.initials: JT
authors.lastname: Jørgensen
authors.affiliation: b Section of General Practice, Department of Public Health , University of Copenhagen , Copenhagen , Denmark ;
authors.forename: John Sahl
authors.initials: JS
authors.lastname: Andersen
authors.affiliation: c Danish Centre for Cancer Research , Danish Cancer Society , Copenhagen , Denmark.
authors.forename: Anne
authors.initials: A
authors.lastname: Tjønneland
authors.affiliation: a Centre for Epidemiology and Screening, Department of Public Health , University of Copenhagen , Copenhagen , Denmark ;
authors.forename: Zorana Jovanovic
authors.initials: ZJ
authors.lastname: Andersen
mesh_terms: D017677:Age Distribution; D000368:Aged; D002908:Chronic Disease / Q000628:therapy; D015331:Cohort Studies; D003718:Denmark; D004032:Diet; D005260:Female; D058006:General Practice / Q000706:statistics & numerical data*; D058005:General Practitioners / Q000706:statistics & numerical data*; D020073:Gravidity; D015438:Health Behavior; D006304:Health Status; D006728:Hormones / Q000627:therapeutic use; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000628:therapy; D008875:Middle Aged; D009369:Neoplasms; D012042:Registries; D012044:Regression Analysis; D017678:Sex Distribution; D011795:Surveys and Questionnaires
chemical_list: D006728:Hormones
keywords: Cohort; Denmark; gender; general practice; health service use; lifestyle; unemployment