THE RELATIONSHIP OF CHRONIC DISEASES AND HEALTH-STATUS TO THE HEALTH-SERVICES UTILIZATION OF OLDER AMERICANS

OBJECTIVE : To study simultaneously the relationships among chronic diseases and physical health status as they affect health services utilization of older adults. DESIGN: Secondary analysis of a large, cross-sectional health interview survey, the Supplement on Aging of the 1984 National Health Interview Survey, using multiple equation methods to evaluate disease-specific impacts on physical health status, the direct impact of specific diseases on utilization of physician services and hospital care, and the indirect impact of specific diseases on utilization, mediated through physical health status. PARTICIPANTS: A total of 11,497 people aged 65 and older, representing a complex, multistage sample of the noninstitutionalized, older adult population of the United States. MEASUREMENTS: Predictor variables included specific chronic diseases (hypertension, arthritis, diabetes, cancer, and atherosclerotic heart disease), self-rated health status, and total number of disabilities. Control variables included age, gender, race, education, social integration. Outcome variables were physician visits and hospital stays. MAIN RESULTS: It was shown that different diseases have different relative impacts on physical health status, probability of utilization, and amount of utilization, if any, and different chronic diseases have a different mix of direct and indirect effects on utilization. CONCLUSION: The impact of chronic disease on health services utilization in a community-dwelling population is not a simple or direct relationship. Diseases vary according to their impact on different types of utilization, their impact on the probability of any health services use versus the amount of use, and on how much their effect on utilization is mediated through health status.