Gender differences in the utilization of health-care services among the older adult population of Spain

urea Redondo-Sendino 0 Pilar Guallar-Castilln 0 Jos Ramn Banegas 0 Fernando Rodrguez-Artalejo 0 0 Address: Department of Preventive Medicine and Public Health. School of Medicine. Universidad Autonoma de Madrid. Madrid , Spain Background: Compared to men, women report greater morbidity and make greater use of health-care services. This study examines potential determinants of gender differences in the utilization of health-care services among the elderly. Methods: Cross-sectional study covering 3030 subjects, representative of the noninstitutionalized Spanish population aged 60 years and over. Potential determinants of gender differences in the utilization of health services were classified into predisposing factors (age and head-of-family status), need factors (lifestyles, chronic diseases, functional status, cognitive deficit and health-related quality of life (HRQL)) and enabling factors (educational level, marital status, head-of-family employment status and social network). Relative differences in the use of each service between women and men were summarized using odds ratios (OR), obtained from logistic regression. The contribution of the variables of interest to the gender differences in the use of such services was evaluated by comparing the OR before and after adjustment for such variables. Results: As compared to men, a higher percentage of women visited a medical practitioner (OR: 1.24; 95% confidence limits (CL): 1.07-1.44), received home medical visits (OR: 1.67; 95% CL: 1.342.10) and took 3 medications (OR: 1.54; 95% CL: 1.34-1.79), but there were no gender differences in hospital admission or influenza vaccination. Adjustment for need or enabling factors led to a reduction in the OR of women compared to men for utilization of a number of services studied. On adjusting for the number of chronic diseases, the OR (95% CL) of women versus men for ingestion of 3 medications was 1.24 (1.06-1.45). After adjustment for HRQL, the OR was 1.03 (0.89-1.21) for visits to medical practitioners, 1.24 (0.98-1.58) for home medical visits, 0.71 (0.580.87) for hospitalization, and 1.14 (0.97-1.33) for intake of 3 medications. After adjustment for the number of chronic diseases and HRQL, the OR of hospitalization among women versus men was 0.68 (0.56-0.84). Conclusion: The factors that best explain the greater utilization of health-care services by elderly women versus men are the number of chronic diseases and HRQL. For equal need, certain inequality was observed in hospital admission, in that it proved less frequent among women. - Background Compared to men, women live longer but, paradoxically, report greater morbidity and disability and make greater use of health-care services at the end of life [1-3]. Nevertheless, the greater utilization of health services by women is not a constant finding but depends in part on the type of service. Women tend to use preventive and diagnostic services more frequently, whereas men make greater use of emergency services [4]. Furthermore, although women are more likely than men to contact a general practitioner [5-12], when it comes to hospital admissions there is no difference [9] or, alternatively, men are hospitalized more frequently than women [13-15]. Utilization of health services by women and men differs according to the health problem for which care is required. Faced with the discovery of a lump in the armpit 2 weeks after a cold, women seek medical attention more frequently than do men, yet there are no differences in the proportion of women and men that immediately seek medical advice when a chest pain appears [16]. After adjustment for social and economic factors, women visit the medical practitioner more often than men when presenting a mood-anxiety disorder or a substance use-antisocial behaviors disorder, though the magnitude of the association between female gender and medical visit is greater in the case of the mood-anxiety disorder [17]. Various types of explanations have been postulated for the greater utilization of health-care services by women. Among these, it should be noted the women's greater need approximated by their worse state of health (greater morbidity, worse perception of health, worse healthrelated quality of life, and greater degree of disability than men), the different social construction of the disease (roles, attitudes, beliefs and behaviors of men and women when they are sick or worried about ill-health), which leads to different processes for seeking health care and differences between women and men in the mere provision of services [2-4]. The factors that determine gender differences in the utilization of health-care services may vary at different stages of life [4,6]. In the reproductive age, the need for gynecological care produces greater health-service use by adult women, but gender differences in utilization tend to diminish at advanced ages. Moreover, in countries with universal, cost-free health-care service coverage, greater utilization by most elderly women could largely be due to their worse state of health, particularly where curative (e.g., visits to the medical practitioner, hospitalization and use of emergency services) rather than preventive (e.g., mammography) or discretional (e.g., dental care) services are involved [13,18]. The study of the factors underlying gender differences in the utilization of health-care services among the elderly is particularly relevant. First, because this population group, whose size is progressively growing, uses these services most frequently; second, because the predominance of women over men increases with age, and health services use tend to be greater among the former. However, there are few studies with this specific objective that target representative samples of the older adult population [15,19,20]. Most research, with the exception of the study by Irizarry in Puerto Rico, comes from Anglo-Saxon countries. It is therefore possible that the results may not be applicable to countries with different socio-cultural characteristics or organization of their health services. In addition, only a few studies have specifically analyzed the influence of health-related quality of life (HRQL) on different patterns of health-services utilization by women and men [9]. Moreover, although lifestyles have been related to health service use [21], we have not found any studies linking lifestyles, such as smoking, alcohol consumption, body mass index or physical activity, with gender differences in health-care services utilization. Accordingly, this study examines gender differences in the utilization of the principal types of health-care services among the older adult population of Spain. In addition, it identifies some of the variables contributing to such differences, including predisposing, enabling and need factors, as considered in the Andersen model of health services use [22]. Methods Study design and subjects This consisted of a cross-sec (...truncated)