TABLE 4—
Estimates of Transition from Medical Use in 2004–2006 to No Medical Use in 2006–2008 Compared with Medical Use in 2004–2008: Health and Retirement Study, United States
| Physician, AOR (95% CI) | Hospital, AOR (95% CI) | Outpatient Surgery, AOR (95% CI) | Home Health, AOR (95% CI) | |
| Needs groups status | ||||
| Health status | ||||
| Fair or poor | 1.08 (0.67, 1.72) | 0.60* (0.67, 1.72) | 0.96 (0.66, 1.39) | 1.23 (0.48, 3.12) |
| Good | 1.11 (0.77, 1.61) | 0.74 (0.77, 1.61) | 1.17 (0.86, 1.60) | 0.87 (0.43, 1.78) |
| Very good or excellent (Ref) | 1.00 | 1.00 | 1.00 | 1.00 |
| Change in health status | ||||
| Worse | 0.44** (0.24, 0.81) | 0.56** (0.39, 0.79) | 0.69* (0.51, 0.93) | 0.50* (0.27, 0.93) |
| Same (Ref) | 1.00 | 1.00 | 1.00 | 1.00 |
| Better | 0.62 (0.30, 1.30) | 0.80 (0.59, 1.09) | 0.96 (0.64, 1.45) | 0.73 (0.36, 1.52) |
| Number of chronic conditions | 0.53** (0.44, 0.62) | 0.89* (0.80, 0.98) | 0.91 (0.83, 1.01) | 0.92 (0.76, 1.11) |
| Change in number of conditions | 0.40** (0.25, 0.65) | 0.58** (0.43, 0.79) | 0.96 (0.76, 1.20) | 0.59 (0.32, 1.06) |
| Body mass index | ||||
| Underweight (< 18.5 kg/m2) | 2.23 (0.66, 7.50) | 1.25 (0.51, 3.11) | 1.20 (0.47, 3.03) | 1.84 (0.29, 11.55) |
| Normal (18.5–24.9 kg/m2; Ref) | 1.00 | 1.00 | 1.00 | 1.00 |
| Overweight (25.0–29.9 kg/m2) | 0.97 (0.59, 1.60) | 0.97 (0.69, 1.36) | 1.04 (0.73, 1.48) | 1.93* (1.02, 3.65) |
| Obese (≥ 30 kg/m2) | 1.02 (0.61, 1.70) | 0.86 (0.62, 1.20) | 1.21 (0.89, 1.67) | 1.00 (0.51, 1.96) |
| Number of ADLs | 0.99 (0.75, 1.31) | 0.89 (0.75, 1.07) | 1.04 (0.85, 1.28) | 0.63** (0.52, 0.76) |
| Change in ADLs | 0.87 (0.59, 1.30) | 0.84* (0.73, 0.97) | 1.12 (0.95, 1.31) | 0.90 (0.72, 1.12) |
| Enabling groups status | ||||
| Household wealth decile | ||||
| 1–3 | 2.74* (1.08, 6.93) | 0.63 (0.37, 1.05) | 1.06 (0.62, 1.79) | 0.16* (0.03, 0.70) |
| 4–6 | 2.06 (0.88, 4.80) | 0.80 (0.49, 1.30) | 1.29 (0.82, 2.04) | 0.12** (0.03, 0.51) |
| 7–9 | 1.94 (0.89, 4.24) | 0.77 (0.48, 1.22) | 1.02 (0.65, 1.62) | 0.19* (0.05, 0.68) |
| 10 (Ref) | 1.00 | 1.00 | 1.00 | 1.00 |
| Household wealth change | ||||
| Increase ≥ 50% | 1.24 (0.64, 2.38) | 0.95 (0.62, 1.45) | 1.52 (1.10, 2.11) | 1.02 (0.43, 2.40) |
| Increase 10%–50% | 1.09 (0.55, 2.14) | 1.21 (0.81, 1.80) | 1.40 (1.01, 1.93) | 1.17 (0.38, 3.56) |
| 10%–10%a (Ref) | 1.00 | 1.00 | 1.00 | 1.00 |
| Decrease 10%–50% | 1.20 (0.64, 2.27) | 1.01 (0.69, 1.48) | 1.60** (1.15, 2.24) | 0.96 (0.35, 2.64) |
| Decrease ≥ 50% | 1.64 (0.93, 2.90) | 1.02 (0.67, 1.54) | 1.53* (1.05, 2.22) | 0.60 (0.25, 1.44) |
| Household incomeb | ||||
| Poor | 2.13 (0.79, 5.76) | 1.28 (0.73, 2.24) | 2.03 (0.92, 4.51) | 2.75 (0.87, 8.73) |
| Low income | 1.24 (0.67, 2.28) | 1.34 (0.98, 1.82) | 1.46 (0.91, 2.34) | 1.06 (0.44, 2.56) |
| Middle income | 1.30 (0.77, 2.18) | 1.20 (0.92, 1.57) | 1.51* (1.10, 208) | 1.20 (0.56, 2.55) |
| High income (Ref) | 1.00 | 1.00 | 1.00 | 1.00 |
| Household income change | ||||
| Increase ≥ 50% | 1.35 (0.76, 2.38) | 0.73 (0.52, 1.02) | 0.97 (0.62, 1.51) | 0.45 (0.19, 1.04) |
| Increase 10%–50% | 1.23 (0.77, 1.96) | 0.85 (0.59, 1.23) | 1.18 (0.80, 1.73) | 1.12 (0.55, 2.28) |
| 10%–10%a (Ref) | 1.00 | 1.00 | 1.00 | 1.00 |
| Decrease 10%–50% | 1.32 (0.79, 2.22) | 0.73 (0.49, 1.10) | 1.13 (0.75, 1.71) | 0.64 (0.33, 1.24) |
| Decrease ≥ 50% | 1.87* (1.04, 3.34) | 0.73 (0.43, 1.25) | 1.17 (0.72, 1.89) | 0.94 (0.39, 2.29) |
| Coverage | ||||
| Public only | 1.08 (0.38, 3.06) | 0.54 (0.25, 1.17) | 0.62 (0.22, 1.77) | 0.05* (0.00, 0.69) |
| Private only | 0.89 (0.31, 2.61) | 1.05 (0.46, 2.39) | 1.05 (0.37, 2.97) | 0.07* (0.01, 0.79) |
| Public and private | 0.94 (0.26, 3.39) | 0.65 (0.25, 1.68) | 0.66 (0.21, 2.08) | 0.04* (0.00, 0.67) |
| No coverage (Ref) | 1.00 | 1.00 | 1.00 | 1.00 |
| Coverage change | ||||
| Always covered | 0.47* (0.23, 0.94) | 0.73 (0.44, 1.21) | 0.94 (0.57, 1.56) | 1.05 (0.40, 2.76) |
| Lost coverage | 0.63 (0.28, 1.43) | 0.67 (0.38, 1.17) | 0.78 (0.43, 1.40) | 0.65 (0.20, 2.07) |
| Gained coverage | 0.86 (0.40, 1.84) | 0.80 (0.52, 1.24) | 0.60* (0.38, 0.94) | 0.91 (0.35, 2.41) |
| Never covered (Ref) | 1.00 | 1.00 | 1.00 | 1.00 |
| Labor force or retirement status | ||||
| Always fully retired | 0.54 (0.27, 1.06) | 0.87 (0.53, 1.41) | 1.23 (0.80, 1.91) | 2.86 (0.83, 9.88) |
| Always in labor force (Ref) | 1.00 | 1.00 | 1.00 | 1.00 |
| Always partially retired | 0.79 (0.38, 1.64) | 1.47 (0.80, 2.71) | 1.07 (0.60, 2.09) | 5.01 (0.83, 30.44) |
| Never in labor force, not retired | 0.59 (0.23, 1.48) | 0.93 (0.50, 1.75) | 2.23 (0.95, 5.24) | 2.06 (0.59, 7.21) |
| Became fully retired | 0.80 (0.35, 1.83) | 0.87 (0.50, 1.54) | 1.34 (0.79, 2.28) | 4.32* (1.11, 16.77) |
| Became partially retired | 1.58 (0.64, 3.87) | 1.48 (0.74, 2.94) | 1.49 (0.77, 2.88) | 7.59 (0.72, 79.68) |
| Joined the labor force | 1.15 (0.72, 1.86) | 0.75 (0.30, 1.89) | 4.51** (1.61, 12.62) | 2.59 (0.21, 32.25) |
| Left labor force, not retired | 1.70 (0.72, 4.00) | 0.87 (0.35, 2.12) | 0.81 (0.34, 1.91) | 2.09 (0.51, 8.58) |
| Predisposing groups status | ||||
| Age, y | ||||
| 51–64 (Ref) | 1.00 | 1.00 | 1.00 | 1.00 |
| 65–69 | 0.45 (0.20, 1.04) | 1.16 (0.78, 1.73) | 1.23 (0.75, 2.00) | 1.46 (0.60, 3.56) |
| 70–74 | 0.71 (0.31, 1.63) | 1.49 (0.98, 2.25) | 1.34 (0.82, 2.20) | 1.00 (0.35, 2.85) |
| 75–79 | 0.85 (0.32, 2.25) | 1.31 (0.80, 2.14) | 1.40 (0.85, 2.30) | 0.53 (0.16, 1.68) |
| ≥ 80 | 1.16 (0.51, 2.63) | 1.54 (0.97, 2.45) | 2.39** (1.36, 4.18) | 0.88 (0.34, 2.26) |
| Gender | ||||
| Woman | 0.70 (0.49, 1.02) | 1.09 (0.84, 1.40) | 0.88 (0.69, 1.13) | 0.79 (0.41, 1.52) |
| Man (Ref) | 1.00 | 1.00 | 1.00 | 1.00 |
| Race/ethnicity | ||||
| Black, non-Hispanic | 1.19 (0.68, 2.09) | 1.29 (0.84, 2.00) | 0.97 (0.67, 1.40) | 0.45* (0.23, 0.90) |
| Hispanic | 1.37 (0.81, 2.31) | 1.46 (0.84, 2.54) | 0.79 (0.42, 1.50) | 0.96 (0.20, 4.62) |
| Other non-Hispanic | 1.17 (0.49, 2.79) | 2.01 (0.85, 4.77) | 0.81 (0.35, 1.89) | 0.25 (0.04, 1.45) |
| White, non-Hispanic (Ref) | 1.00 | 1.00 | 1.00 | 1.00 |
| Education | ||||
| < high school | 2.31** (1.27, 4.21) | 0.87 (0.56, 1.36) | 1.01 (0.65, 1.57) | 0.80 (0.27, 2.34) |
| High school graduate | 1.06 (0.64, 1.76) | 0.89 (0.64, 1.25) | 1.07 (0.78, 1.46) | 1.09 (0.47,2.51) |
| College graduate (Ref) | 1.00 | 1.00 | 1.00 | 1.00 |
| Marital status | ||||
| Widowed or divorced | 1.52 (0.88, 2.61) | 0.99 (0.64, 1.52) | 1.18 (0.76, 1.84) | 1.57 (0.79, 3.14) |
| Never married | 0.91 (0.33, 2.53) | 0.82 (0.42, 1.58) | 0.84 (0.45, 1.58) | 1.62 (0.45, 5.86) |
| Married (Ref) | 1.00 | 1.00 | 1.00 | 1.00 |
| Household size | ||||
| 1 (Ref) | 1.00 | 1.00 | 1.00 | 1.00 |
| 2 | 1.38 (0.77, 2.45) | 1.24 (0.75, 2.07) | 1.38 (0.89, 2.15) | 2.86** (1.34, 6.09) |
| ≥ 3 | 1.09 (0.55, 2.15) | 1.31 (0.86, 2.02) | 1.62* (1.01, 2.59) | 2.71* (1.13, 6.52) |
Note. ADL = activity of daily living; AOR = adjusted odds ratio; CI = confidence intervals; HRS = Health and Retirement Study. The sample size for the multinomial logistic regressions contains 11 847 persons representing 56.036 million older Americans who were in intact reporting households in both the 2006 and 2008 HRS with positive person weights and without missing values for any variables in the model. The AOR point estimate for dichotomous covariates is the estimate of (probability of medical use in 2004–2006 and no medical use in 2006–2008 divided by probability of medical use in both periods) for persons with row characteristic divided by (probability of medical use in 2004–2006 and no medical use in 2006–2008 divided by probability of medical use in both periods) for persons in the reference group. For continuous covariates the AOR point estimate was derived from a 1-unit change in the variable. The adjusted value refers to the inclusion in the regression of the control variables listed in the rows of the table.
10%–10% indicates an increase of ≤ 10% or a decline of ≤ 10%.
Where low income refers to persons in families with incomes 101%–199% of the poverty line (according to US Census); middle income, 201%–400% of the poverty line; and high income, > 400% of the poverty line. Poor persons are ≤ 100% of the poverty line including persons in families with negative income.
*P ≤ .05; **P ≤ .01.