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

OBJECTIVE : To study simultaneously the relationships among chronic di seases and physical health status as they affect health services utili zation of older adults. DESIGN: Secondary analysis of a large, cross-s ectional health interview survey, the Supplement on Aging of the 1984 National Health Interview Survey, using multiple equation methods to e valuate 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 utiliza tion, mediated through physical health status. PARTICIPANTS: A total o f 11,497 people aged 65 and older, representing a complex, multistage sample of the noninstitutionalized, older adult population of the Unit ed States. MEASUREMENTS: Predictor variables included specific chronic diseases (hypertension, arthritis, diabetes, cancer, and atherosclero tic heart disease), self-rated health status, and total number of disa bilities. Control variables included age, gender, race, education, soc ial integration. Outcome variables were physician visits and hospital stays. MAIN RESULTS: It was shown that different diseases have differe nt relative impacts on physical health status, probability of utilizat ion, and amount of utilization, if any, and different chronic diseases have a different mix of direct and indirect effects on utilization. C ONCLUSION: The impact of chronic disease on health services utilizatio n in a community-dwelling population is not a simple or direct relatio nship. Diseases vary according to their impact on different types of u tilization, 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.