Use of care and subsequent mortality: The importance of gender

Peter Franks, Marthe R. Gold, Carolyn M. Clancy

Research output: Contribution to journalArticle

34 Citations (Scopus)

Abstract

Objective. In light of recent discussions on access that have emphasized the need to relate access measures to outcomes, we examined the relationship between three self-reported utilization and access to care measures and the risk of subsequent mortality. Data Sources and Design. A nationally representative sample from the first National Health and Nutrition Examination Survey that included adults 25-64 years of age without publicly funded health insurance was followed prospectively from initial interview in 1971 through 1975. Data Collection. Complete baseline and follow-up information was obtained on 4,491 persons (90) percent). Baseline access and use was assessed with answers to three questions: having a usual source of care, obtaining a general checkup, and not obtaining needed care (or forgone care). The relationships between the access and use measures and mortality by 1987 in men and women were examined using survival analyses. The analyses adjusted for race, and for baseline age, education, income, residence, insurance status, employment status, the presence of morbidity on examination, self-rated health, smoking status, leisure exercise, alcohol consumption, and obesity. Principal Findings. After adjusting for all other baseline variables, not obtaining a general checkup was associated with higher mortality in women (hazard ratio = 1.64 [95% confidence interval = 1.16, 2.32]), but not in men (hazard ratio = 1.07 [95% confidence interval = 0.80, 1.42]). Reporting a usual source of care and forgone care were not related to subsequent mortality in either women or men. Conclusions. Reporting a general checkup is an outcome-related utilization measure in women only. Further development of access and use indicators should address gender differences in health care use.

Original languageEnglish (US)
Pages (from-to)347-363
Number of pages17
JournalHealth Services Research
Volume31
Issue number3
StatePublished - 1996
Externally publishedYes

Fingerprint

mortality
Mortality
gender
Confidence Intervals
Insurance Coverage
Nutrition Surveys
Information Storage and Retrieval
Leisure Activities
Health Insurance
Survival Analysis
confidence
utilization
Alcohol Drinking
Health Status
examination
Obesity
Smoking
Outcome Assessment (Health Care)
Interviews
Exercise

Keywords

  • Access
  • gender
  • mortality

ASJC Scopus subject areas

  • Nursing(all)
  • Health(social science)
  • Health Professions(all)
  • Health Policy

Cite this

Use of care and subsequent mortality : The importance of gender. / Franks, Peter; Gold, Marthe R.; Clancy, Carolyn M.

In: Health Services Research, Vol. 31, No. 3, 1996, p. 347-363.

Research output: Contribution to journalArticle

Franks, P, Gold, MR & Clancy, CM 1996, 'Use of care and subsequent mortality: The importance of gender', Health Services Research, vol. 31, no. 3, pp. 347-363.
Franks, Peter ; Gold, Marthe R. ; Clancy, Carolyn M. / Use of care and subsequent mortality : The importance of gender. In: Health Services Research. 1996 ; Vol. 31, No. 3. pp. 347-363.
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