Division of Health Systems Management and Policy, School of Public Health, University of Memphis, Memphis, Tennessee, USA.
Division of Social and Behavioral Sciences, School of Public Health, University of Memphis, Memphis, Tennessee, USA.
Health Serv Res. 2022 Dec;57(6):1247-1260. doi: 10.1111/1475-6773.13971. Epub 2022 Mar 28.
To examine longitudinal associations between time-varying insomnia symptoms (difficulty initiating sleep, difficulty maintaining sleep, early-morning awakenings, and nonrestorative sleep) and all-cause health care services utilization (HSU), including overnight hospital stays, nursing home stays, and home health care services among middle-aged and older adults.
The Health and Retirement Study (HRS), a nationwide, population-representative survey of primarily middle-aged and older adults in the United States.
This study is an analysis of prospective data from the HRS for a cohort of 13,168 adults (aged ≥50 years; females = 57.7%). Study participants were followed for 16 years. This study focuses on the associations between time-varying insomnia symptoms, both cumulatively and independently, and repeated HSUs. A marginal structural modeling approach was used to capture time-varying biological, psycho-cognitive, and behavioral health factors, and to adjust for selection bias such as differential loss to follow-up. Generalized estimating equations were employed to compute average marginal effects and their 95% confidence intervals.
DATA COLLECTION/EXTRACTION METHODS: We extracted longitudinal data from 2002 through 2018 waves of the HRS.
Experiencing higher numbers of insomnia symptoms on a cumulative scale was associated with higher probabilities of HSU. For instance, the likelihood of overnight hospital stays for individuals reporting one symptom increased from 4.7 percentage points on average (95% CI: 3.7-5.6, p < 0.001), to 13.9 percentage points (95% CI: 10.3-17.5, p < 0.001) for those reporting four symptoms, relative to individuals experiencing no insomnia symptoms. Further, experiencing each of difficulty initiating and maintaining sleep, and nonrestorative sleep, as standalone symptoms, was associated with a higher likelihood of HSU when compared to those not experiencing the symptoms.
The results demonstrate the potential consequences and adverse impacts of insomnia symptoms on HSU among middle-aged and older adults. Future investigations should focus on the underlying causes and health systems pathways linking insomnia symptoms to HSU.
研究中老年人群中随时间变化的失眠症状（入睡困难、睡眠维持困难、早醒和睡眠质量差）与全因医疗保健服务利用（HSU）之间的纵向关联，包括过夜住院、疗养院入住和家庭保健服务。
健康与退休研究（HRS），一项针对美国主要中老年人群的全国性、代表性调查。
本研究对 HRS 的前瞻性数据进行分析，研究对象为 13168 名成年人（年龄≥50 岁；女性占 57.7%）。研究参与者随访了 16 年。本研究重点关注随时间变化的失眠症状与重复 HSU 之间的关联，包括累积和独立的关联。采用边缘结构模型方法来捕捉随时间变化的生物、心理认知和行为健康因素，并调整因失访而产生的选择偏差。采用广义估计方程来计算平均边际效应及其 95%置信区间。
数据收集/提取方法：我们从 HRS 的 2002 年至 2018 年的多个波次中提取了纵向数据。
在累积量表上经历更多数量的失眠症状与更高的 HSU 概率相关。例如，报告一种症状的个体因 HSU 而住院的可能性平均增加了 4.7 个百分点（95%CI：3.7-5.6，p<0.001），而报告四种症状的个体增加了 13.9 个百分点（95%CI：10.3-17.5，p<0.001），与没有失眠症状的个体相比。此外，与没有经历这些症状的个体相比，经历入睡困难和维持睡眠困难以及睡眠质量差的独立症状，与更高的 HSU 可能性相关。
研究结果表明，失眠症状可能对中老年人群的 HSU 产生潜在后果和不良影响。未来的研究应重点关注将失眠症状与 HSU 联系起来的潜在原因和卫生系统途径。
