Joung I M, van der Meer J B, Mackenbach J P
Department of Public Health, Erasmus University Rotterdam, The Netherlands.
Int J Epidemiol. 1995 Jun;24(3):569-75. doi: 10.1093/ije/24.3.569.
Several studies have reported differences in health care utilization by marital status, but usually only controlling for age and sex. Our study aimed at answering the questions: 1) To what extent are differences in health care utilization by marital status due to confounding by socio-demographic variables other than age and sex? and 2) To what extent are these differences due to differences in health status by marital status?
For the analyses we used the baseline data from the Longitudinal Study on Socio-Economic Differences in the Utilization of Health Services. Our study population consisted of 2662 people from the Netherlands, aged 25-74 years. People with diabetes mellitus, chronic non-specific lung diseases, heart conditions and back complaints were overrepresented. Our measures for health care utilization were general practitioner consultation, specialist consultation, hospital admission and use of prescription medicines. Multiple logistic regression models were used to calculate odds ratios (OR) for health care utilization by marital status, controlling for the socio-demographic variables age, sex, educational level, degree of urbanization, religion and country of birth (question 1), and a number of health indicators (question 2).
We found that educational level is an important confounder of the relationship between health care utilization and marital status. In addition differences in health status to a considerable extent explain the higher utilization of health services of widowed and divorced people, but not the lower utilization of the never married. After control for confounding and health status there still were unexplained differences in health care utilization by marital status: e.g. the divorced were more frequently hospitalized (OR = 1.53, 95% CI: 1.03-2.22) than married people.
There are differences in health care utilization by marital status which are not due to confounding by other socio-demographic variables or differences in health status. Further investigation of these differences is necessary, and is likely to benefit from inclusion of socio-psychological variables. Living arrangements should also be included in these future analyses.
多项研究报告了婚姻状况在医疗保健利用方面的差异，但通常仅控制年龄和性别。我们的研究旨在回答以下问题：1）婚姻状况在医疗保健利用方面的差异在多大程度上是由年龄和性别以外的社会人口变量造成的混杂因素所致？2）这些差异在多大程度上是由婚姻状况导致的健康状况差异所致？
为进行分析，我们使用了健康服务利用方面社会经济差异纵向研究的基线数据。我们的研究人群包括来自荷兰的2662人，年龄在25至74岁之间。患有糖尿病、慢性非特异性肺部疾病、心脏病和背部疾病的人群比例过高。我们衡量医疗保健利用的指标包括全科医生咨询、专科医生咨询、住院和处方药使用。使用多元逻辑回归模型计算婚姻状况在医疗保健利用方面的比值比（OR），控制社会人口变量年龄、性别、教育水平、城市化程度、宗教和出生国家（问题1）以及一些健康指标（问题2）。
我们发现教育水平是医疗保健利用与婚姻状况之间关系的一个重要混杂因素。此外，健康状况的差异在很大程度上解释了丧偶和离婚者较高的医疗服务利用率，但不能解释未婚者较低的利用率。在控制了混杂因素和健康状况后，婚姻状况在医疗保健利用方面仍存在无法解释的差异：例如，离婚者比已婚者更频繁住院（OR = 1.53，95% CI：1.03 - 2.22）。
婚姻状况在医疗保健利用方面存在差异，这些差异并非由其他社会人口变量或健康状况差异造成的混杂因素所致。有必要对这些差异进行进一步调查，纳入社会心理变量可能会有所帮助。未来的这些分析中还应包括生活安排。
