Has the prevalence of health care services use increased over the last decade (2001–2009) in elderly people? A Spanish population-based survey

Abstract

Objectives

(1) To describe the prevalence of general practitioner visits and hospitalization according to sex and age groups; (2) to identify which factors are independently associated with a higher use of health care services among elderly Spanish; and (3) to study the time trends in the prevalence of use of health care services 2001–2009.

Study Design

Observational study. We analyzed data from the Spanish National Health Surveys conducted in 2001 (n = 21,058), 2003 (n = 21,650), 2006 (n = 29,478) and 2009 (n = 22,188). We included responses from adults aged 65 years and older.

Outcome measures

The main variables were the number of general practitioner visits in the last 4 weeks and hospitalization in the past year. We stratified the adjusted models by the main variables. We analyzed socio-demographic characteristics, health related variables, using multivariate logistic regression models.

Results

The total number of subjects was 24,349 (15,041 woman, 9309 men). Women were significantly older than men (P < 0.001). Women had higher prevalence of general practitioner visits than men in all surveys. Men had significantly higher prevalence of hospitalizations than women in the years 2001, 2006 and 2009. When we adjusted the hospitalization by possible confounders using logistic regressions, men had a higher probability of being hospitalized than women (OR 1.53, 1.39–1.69). The variables that were significantly associated with a higher use of health care services were lower educational level, worse self-rated health, chronic conditions, polypharmacy, and the level of disability. The number of general practitioner visits among women and men significantly increased from 2001 to 2009 (women: OR 1.43, 1.27–1.61; men: OR 1.71, 1.49–1.97).

Conclusions

The current study revealed an increase in health care services utilization from 2001 to 2009 in the older Spanish population.

Introduction

In recent years, there has been an increase of older people in modern societies [1]. The sheer growth in the older population will likely result in an escalation in the absolute number of persons with morbidity [2] and disability [3], leading to substantial increases in both direct and indirect health care costs [4]. Population aging is considered as a determinant factor of health costs and expenditures [5], [6]. Current governments are confronted with managing resources in the face of an economic recession [3]. In fact, older adults are the most frequent users of health-care services [7]. Factors including an aging population [3], [5], older age [8], [9], [10], gender [10], [11], [12], [13], lower physical activity [7], self-rated health [8], [10], [14], education level [10], [14], [15], comorbidities [5], [9], [13], [16], [17], disability [8], [10], [14], [18], and polypharmacology [19], [20], [21], have been shown to have an important effect on health care service utilization. In Spain, previous studies reported that the elderly population with diabetes [22], worse functional status [10], [14], and limitation in instrumental daily living activities [18] used significantly more health care resources.

Nevertheless, previous research has found that population aging is not the principal determinant of the rise in health care costs [23], [24], [25]. In fact, the higher use of health care services and expensive health care costs were related to health practice patterns [3], and advanced medical technology use [24], [25]. Some authors believe that the aging of the population should be considered as a major cost driver of health care [6], [24]. In Spain, previous studies have shown that the age per se is not directly related to consumption of hospital resources. Therefore, aging itself does not necessarily imply higher health care consumption or increased hospital costs [26].

The Spanish system provides universal health care coverage with limitations regarding mental, pharmacological and dental services. In fact, access from primary to specialized (higher) health care levels is determined by first level physician diagnosis [10]. No previous study has determined time trends of elderly use of health care services in the last decade in Spain. Therefore, this study sought to estimate the prevalence of the use of health care services among Spanish elderly individuals, associated factors and time trends, using four Spanish National Health Surveys conducted from 2001 to 2009 with particular attention to gender differences. The main objectives of this study were: (1) to describe the prevalence of general medical practitioner visits within the last 4 weeks and hospitalization in the last year according to sex and age groups; (2) to identify which factors, including socio-demographic characteristics, heath-related and lifestyle variables and functional disability, were independently associated to a higher use of health care services among elderly Spanish women and men; and (3) to study the time trends in the prevalence of the use of health care services over the period 2001–2009.