Laboratory of Population Health, Max Planck Institute for Demographic Research, Konrad-Zuse-Straße 1, 18057, Rostock, Germany.
Population Research Unit, Department of Social Research, University of Helsinki, Helsinki, Finland.
BMC Public Health. 2019 Jul 29;19(1):1011. doi: 10.1186/s12889-019-7296-x.
Previous research has shown that certain living arrangements, such as living alone, are associated with worse health at older ages. We assessed the association between living arrangements and hospital care use among middle-aged and older adults, and investigated to what extent observed and unobserved individual characteristics explain this association.
Longitudinal Finnish registry data for men and women aged 50-89 years were used for the period 1987-2007. The relationship between living arrangements (based on whether an individual lived with a partner, other adults or alone, and whether they lived with minor/adult children) and heavy hospital care use (i.e., having been in hospital for 8 or more days in a year) was studied. First, we applied logistic regression models and linear probability models controlling for observed time-invariant factors (socioeconomic status measured by education, labour force status, and household income; and marital status), and then individual linear probability models with fixed-effects to further account for unobserved time-invariant individual characteristics in the measurement period. Analyses were done separately for 10 year age-groups.
In the logistic regression models, men and women who lived alone had higher crude odds of heavy hospital care use than those living only with their partner. These odds ratios were highest for men and women in the youngest age category (50-59 years, 1.72 and 1.36 respectively) and decreased with age. Adjusting for observed time-invariant socioeconomic status attenuated these odds by 14-40%, but adjusting for marital status did not affect the results. Lower odds were observed among adults aged 50-59 years who lived with their partner and (minor or adult) children. But odds were higher for individuals aged 60-79 years who co-resided with their adult children, regardless of whether they lived with a partner. Adjusting for observed time-invariant factors generally did not change these results. After further adjusting for unobserved time-invariant individual characteristics in the individual fixed-effects models, most of these associations largely attenuated or disappeared, particularly for ages 80-89 years.
The association between living arrangements and higher use of hospital care at middle and older ages is largely explained by socioeconomic disadvantage and unobserved time-invariant individual characteristics.
先前的研究表明，某些生活安排方式，如独居，与老年人健康状况较差有关。我们评估了中年和老年人的生活安排方式与住院护理使用之间的关系，并探讨了观察到的和未观察到的个体特征在多大程度上解释了这种关系。
使用 1987-2007 年期间年龄在 50-89 岁的男性和女性的芬兰纵向登记数据。研究了生活安排方式（基于个体是否与伴侣、其他成年人或独自生活，以及他们是否与未成年/成年子女生活在一起）与重度住院护理使用（即一年内住院 8 天或以上）之间的关系。首先，我们应用逻辑回归模型和线性概率模型控制观察到的时不变因素（通过教育、劳动力状况和家庭收入衡量的社会经济地位；以及婚姻状况），然后应用个体固定效应的个体线性概率模型进一步解释测量期间未观察到的时不变个体特征。分析分别针对 10 岁年龄组进行。
在逻辑回归模型中，独居的男性和女性比仅与伴侣生活的人更有可能出现重度住院护理使用的高粗比值。这些比值在最年轻的年龄组（50-59 岁，分别为 1.72 和 1.36）中最高，并随着年龄的增长而降低。调整观察到的时不变社会经济地位会使这些比值降低 14-40%，但调整婚姻状况不会影响结果。与伴侣和（未成年或成年）子女一起生活的 50-59 岁成年人的比值较低。但与伴侣一起生活的 60-79 岁成年人与子女同住的比值较高，无论他们是否与伴侣一起生活。调整观察到的时不变因素通常不会改变这些结果。在个体固定效应模型中进一步调整未观察到的时不变个体特征后，这些关联中的大多数在很大程度上减弱或消失，尤其是对于 80-89 岁的年龄组。
在中年和老年时期，生活安排方式与更高的住院护理使用之间的关联在很大程度上可以用社会经济劣势和未观察到的时不变个体特征来解释。
