Skip to main content
NCBI home page
Health Services Research logoLink to Health Services Research
. 1996 Aug;31(3):347–363.

Use of care and subsequent mortality: the importance of gender.

P Franks 1, M R Gold 1, C M Clancy 1
PMCID: PMC1070123  PMID: 8698589

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.

Full text

PDF
347

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Andersen R., Aday L. A. Access to medical care in the U.S.: realized and potential. Med Care. 1978 Jul;16(7):533–546. doi: 10.1097/00005650-197807000-00001. [DOI] [PubMed] [Google Scholar]
  2. Ayanian J. Z., Epstein A. M. Differences in the use of procedures between women and men hospitalized for coronary heart disease. N Engl J Med. 1991 Jul 25;325(4):221–225. doi: 10.1056/NEJM199107253250401. [DOI] [PubMed] [Google Scholar]
  3. Berki S. E., Ashcraft M. L. On the analysis of ambulatory utilization: an investigation of the roles of need, access and price as predictors of illness and preventive visits. Med Care. 1979 Dec;17(12):1163–1181. [PubMed] [Google Scholar]
  4. Bickell N. A., Pieper K. S., Lee K. L., Mark D. B., Glower D. D., Pryor D. B., Califf R. M. Referral patterns for coronary artery disease treatment: gender bias or good clinical judgment? Ann Intern Med. 1992 May 15;116(10):791–797. doi: 10.7326/0003-4819-116-10-791. [DOI] [PubMed] [Google Scholar]
  5. Fihn S. D., Wicher J. B. Withdrawing routine outpatient medical services: effects on access and health. J Gen Intern Med. 1988 Jul-Aug;3(4):356–362. doi: 10.1007/BF02595794. [DOI] [PubMed] [Google Scholar]
  6. Franks P., Clancy C. M., Gold M. R. Health insurance and mortality. Evidence from a national cohort. JAMA. 1993 Aug 11;270(6):737–741. [PubMed] [Google Scholar]
  7. Friedman G. D., Collen M. F., Fireman B. H. Multiphasic Health Checkup Evaluation: a 16-year follow-up. J Chronic Dis. 1986;39(6):453–463. doi: 10.1016/0021-9681(86)90112-8. [DOI] [PubMed] [Google Scholar]
  8. Hayward R. A., Bernard A. M., Freeman H. E., Corey C. R. Regular source of ambulatory care and access to health services. Am J Public Health. 1991 Apr;81(4):434–438. doi: 10.2105/ajph.81.4.434. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Hayward R. A., Shapiro M. F., Freeman H. E., Corey C. R. Inequities in health services among insured Americans. Do working-age adults have less access to medical care than the elderly? N Engl J Med. 1988 Jun 9;318(23):1507–1512. doi: 10.1056/NEJM198806093182305. [DOI] [PubMed] [Google Scholar]
  10. Hibbard J. H., Pope C. R. Gender roles, illness orientation and use of medical services. Soc Sci Med. 1983;17(3):129–137. doi: 10.1016/0277-9536(83)90246-0. [DOI] [PubMed] [Google Scholar]
  11. Idler E. L., Angel R. J. Self-rated health and mortality in the NHANES-I Epidemiologic Follow-up Study. Am J Public Health. 1990 Apr;80(4):446–452. doi: 10.2105/ajph.80.4.446. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Idler E. L., Kasl S. V., Lemke J. H. Self-evaluated health and mortality among the elderly in New Haven, Connecticut, and Iowa and Washington counties, Iowa, 1982-1986. Am J Epidemiol. 1990 Jan;131(1):91–103. doi: 10.1093/oxfordjournals.aje.a115489. [DOI] [PubMed] [Google Scholar]
  13. Kaplan G. A., Camacho T. Perceived health and mortality: a nine-year follow-up of the human population laboratory cohort. Am J Epidemiol. 1983 Mar;117(3):292–304. doi: 10.1093/oxfordjournals.aje.a113541. [DOI] [PubMed] [Google Scholar]
  14. Khan S. S., Nessim S., Gray R., Czer L. S., Chaux A., Matloff J. Increased mortality of women in coronary artery bypass surgery: evidence for referral bias. Ann Intern Med. 1990 Apr 15;112(8):561–567. doi: 10.7326/0003-4819-112-8-561. [DOI] [PubMed] [Google Scholar]
  15. Korn E. L., Graubard B. I. Epidemiologic studies utilizing surveys: accounting for the sampling design. Am J Public Health. 1991 Sep;81(9):1166–1173. doi: 10.2105/ajph.81.9.1166. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Krumholz H. M., Douglas P. S., Lauer M. S., Pasternak R. C. Selection of patients for coronary angiography and coronary revascularization early after myocardial infarction: is there evidence for a gender bias? Ann Intern Med. 1992 May 15;116(10):785–790. doi: 10.7326/0003-4819-116-10-785. [DOI] [PubMed] [Google Scholar]
  17. Lohr K. N., Brook R. H., Kamberg C. J., Goldberg G. A., Leibowitz A., Keesey J., Reboussin D., Newhouse J. P. Use of medical care in the Rand Health Insurance Experiment. Diagnosis- and service-specific analyses in a randomized controlled trial. Med Care. 1986 Sep;24(9 Suppl):S1–87. [PubMed] [Google Scholar]
  18. Lurie N., Ward N. B., Shapiro M. F., Gallego C., Vaghaiwalla R., Brook R. H. Termination of Medi-Cal benefits. A follow-up study one year later. N Engl J Med. 1986 May 8;314(19):1266–1268. doi: 10.1056/NEJM198605083141934. [DOI] [PubMed] [Google Scholar]
  19. Madans J. H., Cox C. S., Kleinman J. C., Makuc D., Feldman J. J., Finucane F. F., Barbano H. E., Cornoni-Huntley J. 10 years after NHANES I: mortality experience at initial followup, 1982-84. Public Health Rep. 1986 Sep-Oct;101(5):474–481. [PMC free article] [PubMed] [Google Scholar]
  20. Madans J. H., Kleinman J. C., Cox C. S., Barbano H. E., Feldman J. J., Cohen B., Finucane F. F., Cornoni-Huntley J. 10 years after NHANES I: report of initial followup, 1982-84. Public Health Rep. 1986 Sep-Oct;101(5):465–473. [PMC free article] [PubMed] [Google Scholar]
  21. McCallum J., Shadbolt B., Wang D. Self-rated health and survival: a 7-year follow-up study of Australian elderly. Am J Public Health. 1994 Jul;84(7):1100–1105. doi: 10.2105/ajph.84.7.1100. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Meininger J. C. Sex differences in factors associated with use of medical care and alternative illness behaviors. Soc Sci Med. 1986;22(3):289–292. doi: 10.1016/0277-9536(86)90124-3. [DOI] [PubMed] [Google Scholar]
  23. Mossey J. M., Shapiro E. Self-rated health: a predictor of mortality among the elderly. Am J Public Health. 1982 Aug;72(8):800–808. doi: 10.2105/ajph.72.8.800. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Orencia A., Bailey K., Yawn B. P., Kottke T. E. Effect of gender on long-term outcome of angina pectoris and myocardial infarction/sudden unexpected death. JAMA. 1993 May 12;269(18):2392–2397. [PubMed] [Google Scholar]
  25. Perloff J. D., Morris N. M. Asking about the usual source of care. An appraisal of health care survey alternatives. Med Care. 1992 Oct;30(10):950–957. doi: 10.1097/00005650-199210000-00007. [DOI] [PubMed] [Google Scholar]
  26. Shea S., Misra D., Ehrlich M. H., Field L., Francis C. K. Predisposing factors for severe, uncontrolled hypertension in an inner-city minority population. N Engl J Med. 1992 Sep 10;327(11):776–781. doi: 10.1056/NEJM199209103271107. [DOI] [PubMed] [Google Scholar]
  27. Steingart R. M., Packer M., Hamm P., Coglianese M. E., Gersh B., Geltman E. M., Sollano J., Katz S., Moyé L., Basta L. L. Sex differences in the management of coronary artery disease. Survival and Ventricular Enlargement Investigators. N Engl J Med. 1991 Jul 25;325(4):226–230. doi: 10.1056/NEJM199107253250402. [DOI] [PubMed] [Google Scholar]
  28. Tobin J. N., Wassertheil-Smoller S., Wexler J. P., Steingart R. M., Budner N., Lense L., Wachspress J. Sex bias in considering coronary bypass surgery. Ann Intern Med. 1987 Jul;107(1):19–25. doi: 10.7326/0003-4819-107-1-19. [DOI] [PubMed] [Google Scholar]
  29. Verbrugge L. M. Gender and health: an update on hypotheses and evidence. J Health Soc Behav. 1985 Sep;26(3):156–182. [PubMed] [Google Scholar]
  30. Weissman J. S., Stern R., Fielding S. L., Epstein A. M. Delayed access to health care: risk factors, reasons, and consequences. Ann Intern Med. 1991 Feb 15;114(4):325–331. doi: 10.7326/0003-4819-114-4-325. [DOI] [PubMed] [Google Scholar]
  31. Wilensky G. R., Rossiter L. F. The relative importance of physician-induced demand in the demand for medical care. Milbank Mem Fund Q Health Soc. 1983 Spring;61(2):252–277. [PubMed] [Google Scholar]
  32. Wingard D. L. The sex differential in morbidity, mortality, and lifestyle. Annu Rev Public Health. 1984;5:433–458. doi: 10.1146/annurev.pu.05.050184.002245. [DOI] [PubMed] [Google Scholar]

Articles from Health Services Research are provided here courtesy of Health Research & Educational Trust

RESOURCES