Table 2.
Determinants of health care utilization (GP visits, specialist visits and hospital admission) in late life among community-dwelling individuals.
| Number of GP visits | Medical specialists–number of visits | Hospital admission (yes/no) | ||||
|---|---|---|---|---|---|---|
| Independent variables | IRR | 95%CI | IRR | 95%CI | OR | 95%CI |
| Depressive symptoms (GDS) | 1.03*** | (1.01–1.04) | 1.03** | (1.01–1.04) | 1.08** | (1.02–1.13) |
| Age | 1.01 | (1.00–1.02) | 0.97*** | (0.96–0.98) | 0.98 | (0.95–1.01) |
| Female (ref: male) | 1.10* | (1.00–1.20) | 0.99 | (0.89–1.11) | 0.71* | (0.51–0.98) |
| Education (CASMIN) (ref: low) | ||||||
| Middle | 0.97 | (0.89–1.06) | 1.08 | (0.93–1.20) | 0.85 | (0.56–1.22) |
| High | 0.99 | (0.89–1.11) | 1.06 | (0.97–1.68) | 0.83 | (0.66–3.72) |
| Marital status: (ref: married, living with spouse) | ||||||
| Married, living separated | 0.98 | (0.76–1.26) | 1.28+ | (0.97–1.68) | 1.57 | (0.66–3.72) |
| Single | 0.91 | (0.73–1.13) | 0.97 | (0.75–1.25) | 1.00 | (0.44–2.26) |
| Divorced | 1.30** | (1.07–1.58) | 1.06 | (0.83–1.35) | 1.58 | (0.78–3.20) |
| Widowed | 1.06 | (0.92–1.22) | 1.08 | (0.91–1.28) | 0.96 | (0.56–1.67) |
| Living situation: (ref: alone) | ||||||
| Living together with spouse/partner/relative | 1.03 | (0.90–1.18) | 1.14 | (0.97–1.34) | 0.72 | (0.43–1.23) |
| Retirement home/assisted living/ nursing home | 1.10 | (0.93–1.29) | 0.98 | (0.80–1.20) | 0.86 | (0.47–1.58) |
| Health insurance: (ref: statutory) | ||||||
| Private health insurance | 1.37*** | (1.14–1.64) | 0.83 | (0.65–1.05) | 1.64 | (0.88–3.06) |
| High Social support (ESSI) (ref: low) | 1.04 | (0.95–1.14) | 1.11* | (1.00–1.24) | 1.17 | (0.81–1.69) |
| Cognitive function (MMSE) | 0.98* | (0.97–1.00) | 1.00 | (0.98–1.02) | 1.02 | (0.96–1.08) |
| Chronic disease score (CDS) | 1.05*** | (1.03–1.06) | 1.02** | (1.01–1.04) | 1.11*** | (1.06–1.17) |
| Functional impairment (ADL) (ref: no) | 1.16*** | (1.07–1.25) | 1.08+ | (0.99–1.17) | 1.74** | (1.25–2.42) |
| Visual impairment (ref: no) | 0.92* | (0.85–1.00) | 1.01 | (0.92–1.10) | 1.06 | (0.79–1.44) |
| Hearing impairment (ref: no) | 0.97 | (0.90–1.05) | 1.14** | (1.04–1.24) | 1.26 | (0.95–1.67) |
| Constant | 8.25*** | (3.26–20.86) | 56.77*** | (18.44–174.78) | 0.39 | (0.02–10.24) |
| Random part | Yes | Yes | Yes | |||
| Observations | 1,843 | 1,846 | 1,843 | |||
| Individuals | 1,118 | 1,119 | 1,118 | |||
Results of multilevel random intercept negative binominal regression (IRR) and the random-effects logistic regression (OR). AgeMooDe–German “Late-life depression in primary care: needs, health care utilization and costs”.
Incidence-rate ratios (IRR) and odds-ratios (OR) with 95% confidence intervals (95% CI) are reported. Depression—short version of the Geriatric Depression Scale, which contains 15 items (GDS-SF) (29); Educational level (CASMIN) low, middle, high [33]; Social support—German Version of the ENRICHD Social Support Inventory—ESSI (35), range 5–25, values lower or equal to 18 indicated low social support (36); Cognitive function–Mini-Mental State Examination (MMSE), from 0 (worst) to 30 (best) (39); Chronic disease score (CDS)—burden of multimorbidity, range 0–12, higher scores indicate higher morbidity (38); Functional impairment-−24-item scale (instrumental) activities of daily living (IADL/ADL). Patients who had difficulty on at least one ADL/IADL were classified as functionally impaired (37). ***p <0.001, **p <0.01, *p <0.05.