USE OF CARE AND SUBSEQUENT MORTALITY - THE IMPORTANCE OF GENDER

Objective. In light of recent discussions on access that have emphasiz ed the need to relate access measures to outcomes, we examined the rel ationship between three self-reported utilization and access to care m easures 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 fr om initial interview in 1971 through 1975. Data Collection. Complete b aseline and follow-up information was obtained on 4,491 persons (90 pe rcent). Baseline access and use was assessed with answers to three que stions: having a usual source of care, obtaining a general checkup, an d not obtaining needed care (or forgone care). The relationships betwe en 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-rat ed health, smoking status, leisure exercise, alcohol consumption, and obesity. Principal Findings. After adjusting for all other baseline va riables, not obtaining a general checkup was associated with higher mo rtality 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. Conclusio ns. Reporting a general checkup is an outcome-related utilization meas ure in women only. Further development of access and use indicators sh ould address gender differences in health care use.