Ng Yong, Low Abigail Jia Ai, Chan Clement, Lim Yu Liang, Lee Chien Earn, Tan Hiang Khoon, Ng Qin Xiang
NUS Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
School of Medicine, University of Western Australia, Singapore, Singapore.
J Health Popul Nutr. 2024 Dec 18;43(1):218. doi: 10.1186/s41043-024-00715-z.
Middle-aged adults, defined as individuals between the ages of 45 and 64, represent a significant yet under researched group of healthcare service users. This scoping review aimed to provide a comprehensive overview of the patterns of healthcare utilisation and the factors contributing to them within this demographic.
Following PRISMA-ScR guidelines and the framework proposed by Arksey and O'Malley, a systematic literature search was conducted across PubMed, EMBASE, and the Cochrane Library databases from their inception until July 2023. Key search terms such as "healthcare utilisation" and "middle-aged" were used to identify relevant studies. Articles were included if they were original cohort, case-control, or cross-sectional studies published in English. The findings were then synthesised narratively, by identifying recurring concepts and grouping them into broader themes. The themes were categorised according to the Andersen healthcare utilisation model's three factors: predisposing factors, enabling factors, and need-related factors.
After screening 4,810 records, a total of 25 articles were selected for final analysis, comprising 15 from developed countries and 10 from developing countries. Consistent factors influencing healthcare utilisation included multimorbidity, socioeconomic status, and poor health behaviours. Differences emerged across contexts: in developed countries, healthcare utilisation was influenced by lifestyle behaviours and access to private care, while in developing countries, socioeconomic inequalities and limited insurance coverage played more dominant roles. Healthcare system structures likely shaped utilisation patterns.
Healthcare utilisation among middle-aged adults is driven by an interplay of medical, social, and economic factors that vary across contexts. Common contributors, such as multimorbidity and poor health behaviours, highlight the need for targeted interventions and policies focusing on primary and preventive care to address the long-term burden of healthcare utilisation. This demographic faces unique challenges in managing healthcare decisions amidst varying systemic and individual-level challenges, which should be further studied.
中年成年人定义为年龄在45至64岁之间的个体，是医疗服务使用者中一个规模庞大但研究不足的群体。本范围综述旨在全面概述这一人群的医疗服务利用模式及其影响因素。
遵循PRISMA-ScR指南以及阿克西和奥马利提出的框架，对PubMed、EMBASE和Cochrane图书馆数据库从建库至2023年7月进行了系统的文献检索。使用“医疗服务利用”和“中年”等关键检索词来识别相关研究。纳入的文章需为以英文发表的原创队列研究、病例对照研究或横断面研究。然后通过识别反复出现的概念并将其归纳为更广泛的主题，对研究结果进行叙述性综合。这些主题根据安德森医疗服务利用模型的三个因素进行分类：易患因素、促成因素和需求相关因素。
在筛选了4810条记录后，共选择了25篇文章进行最终分析，其中15篇来自发达国家，10篇来自发展中国家。影响医疗服务利用的一致因素包括多种疾病并存、社会经济地位和不良健康行为。不同背景下存在差异：在发达国家，医疗服务利用受生活方式行为和获得私人护理的机会影响，而在发展中国家，社会经济不平等和保险覆盖范围有限发挥了更主要的作用。医疗系统结构可能塑造了利用模式。
中年成年人的医疗服务利用受到医疗、社会和经济因素相互作用的驱动，这些因素因背景而异。多种疾病并存和不良健康行为等常见因素凸显了需要有针对性的干预措施和侧重于初级和预防保健的政策，以应对医疗服务利用的长期负担。这一人群在应对不同的系统和个体层面挑战时，在管理医疗决策方面面临独特的挑战，应进一步开展研究。
