Gender, psychosocial factors and the use of medical services: a longitudinal analysis

Many researchers have reported gender differences in levels of reported sym ptoms, morbidity, mortality and medical care utilization, but the debate co ntinues about the underlying causes of these differences. Some have argued that women use more medical services because they are more sensitive to sym ptoms and interested in health, while others believe that women's greater s ervice utilization arises from the fact that women experience more morbidit ies than do men. To date, these questions have not been studied prospective ly. Using data from a household interview survey carried out in 1970-1971 a nd linked to 22 years of health services utilization records, we explored t he effects of gender, self-reported health status, mental and physical symp tom levels, health knowledge, illness behaviors and health concerns and int erest on the long-term use of health services. After controlling for the af orementioned factors, female gender remained an independent predictor of hi gher utilization over the 22-year period studied, and psychosocial and heal th factors measured at the initial interview predicted service use even 19- 22 years later. Controlling for factors identified as likely causes of gend er-related differences in healthcare utilization, gender remains an importa nt predictor of medical care use before and after removing sex-specific uti lization. In addition, the consistent predictive ability of attitudinal and behavioral factors, combined with the finding that health knowledge did no t predict utilization, indicates that efforts to help patients assess their service needs should target the attitudinal and behavioral factors that va ry with gender, rather than health-related knowledge alone. (C) 1999 Elsevi er Science Ltd. All rights reserved.