GENETIC AND ENVIRONMENTAL CONTRIBUTIONS TO HEALTH-CARE NEED AND UTILIZATION - A TWIN ANALYSIS

Objective. An exploratory study to examine the genetic and environment al influences on healthcare-seeking behavior for four health condition s (high blood pressure, mental health problems, joint disorders, and h earing problems). Data Sources. Data collected from 3,602 male-male tw in pair members of the Vietnam Era Twin (VET) Registry. Study Design. Varying models for the relationship between genetic and environmental influences on health condition liability and on treatment use were tes ted in an attempt to explain the relative contributions of additive ge netic, common, and unique environmental effects to health condition an d treatment use. Data Collection. A mail and telephone survey of gener al health status was administered in 1987 to VET Registry twins. Princ ipal Findings. Variance component estimates under the best-fitting mod el for the genetic component ranged from 24 percent to 52 percent for the condition status and from 42 percent to 56 percent for treatment-s eeking behavior. Conclusions. Utilization models that consider only en vironmental parameters will leave a large percentage of variability un explained. Familial patterns have an impact not only on disease suscep tibility but also on healthcare utilization, thereby having lifelong i mplications for social and fiscal constraints placed on the healthcare system. Thus, explanatory models for healthcare utilization behavior should consider the contribution of genetic factors in the decision to seek and use health services.