Association between Primary Care Utilization and Emergency Room or Hospital Inpatient Services Utilization among the Middle-Aged and Elderly in a Self-Referral System: Evidence from the China Health and Retirement Longitudinal Study 2011–2018
Abstract
:1. Introduction
2. Materials and Methods
2.1. Assessment Framework
2.2. Data Sources
2.3. Variables
2.3.1. Dependent Variables
2.3.2. Exposure
2.3.3. Covariates
2.4. Statistical Analysis
3. Results
3.1. Descriptive Statistics
3.2. Association between Outpatient Visits Types and ER or Hospital Inpatient Services Utilization
3.3. Trend Test of Association between Outpatient Visits Types and ER or Hospital Inpatient Services Utilization
4. Discussion
4.1. Main Findings
4.2. Association between Outpatient Visits Types and ER or Hospital Inpatient Services Utilization
4.3. Trend Test of Association between Outpatient Visits Types and ER or Hospital Inpatient Services Utilization
4.4. Study Limitations
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Appendix A
Variables | Indicators | Definition | Assignment |
---|---|---|---|
Independent Variables | |||
Outpatient service utilization | Outpatient visit types | Primary care outpatient visits indicated that the respondent visited a community healthcare center, township hospital, health care post or village clinic/private clinic for outpatient care in the last month. Hospital outpatient visits indicated that the respondent visited a general hospital, specialized hospital and Chinese medicine hospital in the last month. | Hospital outpatient visit = 0, Primary care outpatient visit = 1. |
Dependent variables | |||
Hospital inpatient service utilization | Hospitalization or not | Whether the respondent received inpatient care in the past year. | No = 0, Yes = 1. |
Number of hospitalizations | The number of times the respondent received inpatient care during the past year. | Discrete variable. | |
Length of hospitalization in days | The number of days the respondent received inpatient care during the past year. | Discrete variable. | |
ER service utilization | ER visits or not | Whether the respondent received emergency care in the last month. | No = 0, Yes = 1. |
Covariates | |||
Availability and characteristic of health resources | Economic region | Whether the respondent’s current address (province-level) is in a west, middle or east area. | West = 0, Middle = 1, East = 2. |
GDP per capital (PGDP) | Gross domestic product per capita at respondent’s current address; current address refers to the prefecture-level city. | Continuous variable. | |
Current residence | Whether the respondent’s current address is in a rural or urban area. | Rural = 0, Urban = 1. | |
Health status | Self-reported health status | Respondent’s own perceptions of his/her own health. | Poor = 0, Fair = 1, Good = 2. |
ADL limitations | Whether the respondent had any difficulty with dressing, bathing or showering, eating, getting into or out of bed, using the toilet or controlling urination and defecation. Respondents who had difficulty with any one of the six activities listed above were defined as having ADL limitations. | No = 0, Yes = 1. | |
IADL limitations | Whether respondent had any difficulty with doing household chores, preparing hot meals, shopping for groceries, taking medications or managing your money. Respondents who had difficulty with any one of the five activities listed above were defined as having IADL limitations. | No = 0, Yes = 1. | |
Depression | Respondent whose CESD ≥10 was defined as having depression. | No = 0, Yes = 1. | |
Individual demographic characteristic | Age group | Actual date of birth of respondent. | 45–49 years old = 0, 50–59 years old = 1, 60–69 years old = 2, 70–79 years old = 3, ≥80 years old = 4. |
Sex | Sex of respondent. | Female = 0, Male = 1. | |
Marital status | Marital status of respondent. With spouse included married and living with spouse, and married but not living with spouse temporarily for reasons, such as work, Without spouse included separated, divorced, widowed, and never married. | Without spouse = 0, With spouse = 1. | |
Education | The respondent’s highest level of education. | Elementary school and below = 0, Middle school and high school = 1, College and above = 2. | |
Work status | Whether the respondent has a job and whether the respondent is currently retired. | Unemployed = 0, Employed = 1, Retired = 2. | |
Health need | Smoking | Whether the respondent has ever smoked or has totally quit. | Never = 0, Used = 1, Now = 2. |
Drinking | Whether and how often the respondent drank any alcoholic beverages in the past year. | Never = 0, <1 time per month = 1, >=1 times per month = 2. | |
Number of chronic diseases | The number of chronic diseases of respondent that have been diagnosed by a doctor. Chronic diseases included hypertension, dyslipidemia, diabetes, cancer or malignant tumor, chronic lung diseases, liver disease, heart disease, stroke, kidney disease, stomach or other digestive diseases, emotional or nervous problems, memory-related disease, arthritis or rheumatism, and asthma. | 0 = 0, 1 = 1, more than 2 = 2. | |
Frequency of social activity | Whether and how often the respondent engaged in any social activities in the past month. | None = 0, Not regular = 1, Almost every week = 2, Almost every day = 3. | |
Enabling factors | The per capita household consumption expenditure (PCE) | The per capita household consumption expenditure of the respondents’ households in the past year. | Continuous variable Considering the distribution of PCE, we use the natural logarithm of PCE (ln PCE) to measure the economic level of the household. |
Medical insurance status | The type of medical insurance of the respondent. Urban and rural resident medical insurance integrated urban resident medical insurance and new rural cooperative medical insurance. | None = 0, Urban employee medical insurance = 1, Urban and rural resident medical insurance = 2, Other medical insurance = 3. | |
Family support | Number of caregivers | The number of people who helped the respondent if the respondent had any difficulty in ADL or IADL. | 0 = 0, 1 = 1, 2–3 = 2, ≥4 = 3. |
Living arrangement | Household members who lived with the respondent. | Alone = 0, with other relatives = 1, with spouse = 2, with offspring = 3. |
Outpatient Visit Types | ER Visits or Not | Hospitalization or Not | Number of Hospitalizations | Length of Hospitalization Days |
---|---|---|---|---|
Adjusted OR (95% CI) | Adjusted OR (95% CI) | Adjusted IRR (95% CI) | Adjusted IRR (95% CI) | |
Self reported health status = poor | ||||
Ref: Hospital outpatient visits | ||||
Primary care outpatient visits | 0.156 *** (0.100, 0.243) | 0.646 *** (0.542, 0.771) | 1.087 (0.874,1.352) | 0.857 * (0.761, 0.964) |
Self reported health status = fair | ||||
Ref: Hospital outpatient visits | ||||
Primary care outpatient visits | 0.111 *** (0.051, 0.243) | 0.557 *** (0.426, 0.730) | 0.970 (0.620, 1.518) | 0.948 (0.798, 1.126) |
Self reported health status = good | ||||
Ref: Hospital outpatient visits | ||||
Primary care outpatient visits | 0.114 *** (0.059, 0.220) | 0.636 ** (0.464, 0.870) | 0.718 (0.421,1.227) | 0.815 * (0.692, 0.960) |
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2011 (n = 2190) | 2013 (n = 2463) | 2015 (n = 1214) | 2018 (n = 1677) | ||||||
---|---|---|---|---|---|---|---|---|---|
Hospital Outpatient | Primary Care Outpatient | Hospital Outpatient | Primary Care Outpatient | Hospital Outpatient | Primary Care Outpatient | Hospital Outpatient | Primary Care Outpatient | ||
Economic region (%) | West | 187 (28.38) | 498 (32.53) | 252 (27.21) | 556 (36.17) $ | 141 (31.13) | 260 (34.17) | 229 (30.17) | 319 (34.75) |
Middle | 259 (39.30) | 563 (36.77) | 319 (34.45) | 577 (37.54) | 160 (35.32) | 263 (34.56) | 292 (38.47) | 309 (33.66) | |
East | 213 (32.32) | 470 (30.70) | 355 (38.34) | 404 (26.28) | 152 (33.55) | 238 (31.27) | 238 (31.36) | 290 (31.59) | |
PGDP, mean (SD) | 36,982.30 (21,940.17) | 32,471.47 (19,918.12) $ # | 49,101.86 (29,244.55) | 39,804.78 (24,459.99) $ | 51,337.25 (31,650.07) | 45,033.61 (27,548.94) $ | 59,428.61 (34,705.76) | 51,235.13 (29,271.44) $ | |
Current residence, n (%) | Rural | 341 (51.75) | 1099 (71.78) $ # | 480 (51.84) | 1056 (68.71) $ | 254 (56.07) | 554(72.80) $ | 415 (54.68) | 674 (73.42) $ |
Urban | 318 (48.25) | 432 (28.22) | 446 (48.16) | 481 (31.29) | 199 (43.93) | 207 (27.20) | 344 (45.32) | 244 (26.58) | |
Self-reported health status, n (%) | Poor | 313 (47.50) | 717 (46.83) # | 375 (40.50) | 602 (39.17) | 196 (43.27) | 313 (41.13) | 329 (43.4) | 410 (44.66) |
Fair | 143 (21.70) | 318 (20.77) | 225 (24.30) | 382 (24.85) | 100 (22.08) | 179 (23.52) | 346 (45.65) | 414 (45.10) | |
Good | 203 (30.80) | 496 (32.40) | 326 (35.21) | 553 (35.98) | 157 (34.66) | 269 (35.35) | 83 (10.95) | 94 (10.24) | |
ADL limitations, n (%) | No | 516 (78.30) | 1130 (73.81) $ # | 714 (77.11) | 1152 (74.95) | 341 (75.28) | 541(71.09) | 576 (75.89) | 612 (66.67) $ |
Yes | 143 (21.70) | 401 (26.19) | 212 (22.89) | 385 (25.05) | 112 (24.72) | 220 (28.91) | 183 (24.11) | 306 (33.33) | |
IADL limitations, n (%) | No | 477 (72.38) | 1067 (69.69) # | 682 (73.65) | 1109 (72.15) | 319 (70.42) | 547 (71.88) | 536 (70.62) | 574 (62.53) $ |
Yes | 182 (27.62) | 464 (30.31) | 244 (26.35) | 428 (27.85) | 134 (29.58) | 214 (28.12) | 223 (29.38) | 344 (37.47) | |
Depression, n (%) | No | 347 (52.66) | 681 (44.48) $ # | 560 (60.48) | 871 (56.67) | 269 (59.38) | 403 (52.96) $ | 422 (55.60) | 416 (45.32) $ |
Yes | 312 (47.34) | 850 (55.52) | 366 (39.52) | 666 (43.33) | 184 (40.62) | 358 (47.04) | 337 (44.40) | 502 (54.68) | |
Age group, n (%) | 45–49 | 97 (14.72) | 197 (12.87) $ # | 104 (11.23) | 182 (11.84) | 21 (4.64) | 40 (5.26) | 2 (0.26) | 2 (0.22) |
50–59 | 249 (37.78) | 494 (32.27) | 345 (37.26) | 505 (32.86) | 157 (34.66) | 247 (32.46) | 281 (37.02) | 288 (31.37) | |
60–69 | 207 (31.41) | 527 (34.42) | 293 (31.64) | 541 (35.20) | 169 (37.31) | 286 (37.58) | 250 (32.94) | 355 (38.67) | |
70–79 | 86 (13.05) | 247 (16.13) | 145 (15.66) | 244 (15.88) | 89 (19.65) | 139 (18.27) | 182 (23.98) | 209 (22.77) | |
≥80 | 20 (3.03) | 66 (4.31) | 39 (4.21) | 65 (4.23) | 17 (3.75) | 49 (6.44) | 44 (5.8) | 64 (6.97) | |
Sex, n (%) | Female | 372 (56.45) | 923 (60.29) | 563 (60.80) | 914 (59.47) | 228 (50.33) | 454 (59.66) $ | 429 (56.52) | 571 (62.20) $ |
Male | 287 (43.55) | 608 (39.71) | 363 (39.20) | 623 (40.53) | 225 (49.67) | 307 (40.34) | 330 (43.48) | 347 (37.80) | |
Marital status, n (%) | Without spouse | 75 (11.38) | 219 (14.30) # | 130 (14.04) | 226 (14.70) | 95 (20.97) | 182 (23.92) | 101 (13.31) | 165 (17.97) $ |
With spouse | 584 (88.62) | 1312 (85.70) | 796 (85.96) | 1311 (85.30) | 358 (79.03) | 579 (76.08) | 658 (86.69) | 753 (82.03) | |
Education, n (%) | Elementary school and below | 406 (61.61) | 1208 (78.90) $ # | 536 (57.88) | 1155 (75.15) $ | 254 (56.07) | 572 (75.16) $ | 446 (58.76) | 716 (78.00) $ |
Secondary school | 230 (34.90) | 313 (20.44) | 347 (37.47) | 370 (24.07) | 175 (38.63) | 186 (24.44) | 290 (38.21) | 198 (21.57) | |
College and above | 23 (3.49) | 10 (0.65) | 43(4.64) | 12 (0.78) | 24 (5.30) | 3 (0.39) | 23 (3.03) | 4 (0.44) | |
Work status, n (%) | Unemployed | 303 (45.98) | 594 (38.80) $ # | 382 (41.25) | 508 (33.05) $ | 175 (38.63) | 273 (35.87) $ | 279 (36.76) | 306 (33.33) $ |
Employed | 227 (34.45) | 870 (56.83) | 335 (36.18) | 913 (59.40) | 160 (35.32) | 432 (56.77) | 281 (37.02) | 543 (59.15) | |
Retired | 129 (19.58) | 67 (4.38) | 209 (22.57) | 116 (7.55) | 118 (26.05) | 56 (7.36) | 199 (26.22) | 69 (7.52) | |
Smoking, n (%) | Never | 435 (66.01) | 998 (65.19) $ # | 618 (66.74) | 987 (64.22) $ | 250 (55.19) | 480 (63.07) $ | 469 (61.79) | 570 (62.09) |
Used to smoke | 94 (14.26) | 138 (9.01) | 111 (11.99) | 132 (8.59) | 99 (21.85) | 110 (14.45) | 146 (19.24) | 146(15.90) | |
Now | 130 (19.73) | 395 (25.80) | 197 (21.27) | 418 (27.20) | 104 (22.96) | 171 (22.47) | 144 (18.97) | 202 (22.00) | |
Drinking, n (%) | Never | 488 (74.05) | 1097 (71.65) | 694 (74.95) | 1090 (70.92) $ | 298 (65.78) | 537 (70.57) | 551 (72.60) | 670 (72.98) $ |
<1 time per month | 40 (6.07) | 118 (7.71) | 74 (7.99) | 120 (7.81) | 42 (9.27) | 56 (7.36) | 63 (8.30) | 49 (5.34) | |
≥1 times per month | 131 (19.88) | 316 (20.64) | 158 (17.06) | 327 (21.28) | 113 (24.94) | 168 (22.08) | 145 (19.1) | 199 (21.68) | |
Number of chronic diseases, n (%) | 0 | 101 (15.33) | 283 (18.48) # | 133 (14.36) | 265 (17.24) | 61 (13.47) | 128 (16.82) $ | 43 (5.67) | 77 (8.39) |
1 | 179 (27.16) | 420 (27.43) | 238 (25.70) | 419 (27.26) | 84 (18.54) | 174 (22.86) | 123 (16.21) | 147 (16.01) | |
≥2 | 379 (57.51) | 828 (54.08) | 555 (59.94) | 853 (55.50) | 308 (67.99) | 459 (60.32) | 593 (78.13) | 694 (75.6) | |
Frequency of social activity, n (%) | None | 321 (48.71) | 762 (49.77) # | 366 (39.52) | 625 (40.66) | 172 (37.97) | 317 (41.66) | 305 (40.18) | 422 (45.97) $ |
Not regular | 89 (13.51) | 224 (14.63) | 129 (13.93) | 238 (15.48) | 74 (16.34) | 130 (17.08) | 117 (15.42) | 144 (15.69) | |
Almost every week | 70 (10.62) | 180 (11.76) | 108 (11.66) | 191 (12.43) | 61 (13.47) | 93 (12.22) | 88 (11.59) | 112 (12.20) | |
Almost every day | 179 (27.16) | 365 (23.84) | 323 (34.88) | 483 (31.42) | 146 (32.23) | 221 (29.04) | 249(32.81) | 240 (26.14) | |
Medical insurance status, n (%) | None | 23 (3.49) | 79 (5.16) $ # | 34 (3.67) | 36 (2.34) $ | 19 (4.19) | 27 (3.55) $ | 11 (1.45) | 18 (1.96) $ |
Urban Employee Basic Medical Insurance | 112 (17.00) | 56 (3.66) | 198 (21.38) | 91 (5.92) | 98 (21.63) | 57 (7.49) | 154 (20.29) | 49 (5.34) | |
Urban and rural resident medical insurance | 469 (75.27) | 1379 (90.07) | 664 (71.17) | 1400 (91.09) | 313 (69.09) | 667 (87.65) | 570 (75.10) | 846 (92.16) | |
other medical insurance | 28 (4.25) | 17 (1.11) | 30 (3.24) | 10 (0.65) | 23 (5.08) | 10 (1.31) | 24 (3.16) | 5 (0.54) | |
PCE/yuan, mean (SD) | 4070.36 (3010.56) | 2793.09 (2161.98) | 3138.75 (2289.70) | 2222.34 (1665.37) | 6372.15 (5190.50) | 4487.86 (3703.05) | 8878.39 (6564.50) | 5851.12 (4792.40) | |
ln PCE, mean (SD) | 8.04 (0.77) | 7.67 (0.73) $ # | 7.80 (0.72) | 7.46 (0.72) $ | 8.44 (0.82) | 8.13 (0.74) $ | 8.82 (0.77) | 8.39 (0.76) $ | |
Number of caregivers, n (%) | 0 | 525 (79.67) | 1245 (81.32) # | 742 (80.13) | 1212 (78.85) | 344 (75.94) | 580 (76.22) | 575 (75.76) | 637 (69.39) $ |
1 | 13 (1.97) | 38 (2.48) | 105 (11.34) | 193 (12.56) | 54 (11.92) | 67 (8.80) | 87 (11.46) | 129 (14.05) | |
2–3 | 108 (16.39) | 208 (13.59) | 61 (6.59) | 103 (6.70) | 30 (6.62) | 69 (9.07) | 51 (6.72) | 72 (7.84) | |
≥4 | 13 (1.97) | 40 (2.61) | 18 (1.94) | 29 (1.89) | 25 (5.52) | 45 (5.91) | 46 (6.06) | 80 (8.71) | |
Living arrangement, n (%) | Alone | 28 (4.25) | 108 (7.05) $ # | 95 (10.26) | 153 (9.95) | 66 (14.57) | 110 (14.45) | 86 (11.33) | 117 (12.75) |
With relatives | 32 (4.86) | 118 (7.71) | 48 (5.18) | 120 (7.81) | 31 (6.84) | 78 (10.25) | 48 (6.32) | 34 (3.70) | |
With spouse | 568 (86.19) | 1218 (79.56) | 768 (82.94) | 1237 (80.48) | 186 (41.06) | 286 (37.58) | 413 (54.41) | 486 (52.94) | |
With offspring | 31 (4.70) | 87 (5.68) | 15 (1.62) | 27 (1.76) | 170 (37.53) | 287 (37.71) | 212 (27.93) | 281 (30.61) |
Hospital Outpatient | Primary Care Outpatient | p Value | Total | ||
---|---|---|---|---|---|
Economic region (%) | West | 809 (28.92) | 1633 (34.40) | <0.001 | 2442 (32.37) |
Middle | 1030 (36.83) | 1712 (36.06) | 2742 (36.35) | ||
East | 958 (34.25) | 1402 (29.53) | 2360 (31.28) | ||
PGDP, mean (SD) | 49,410.71 (30,805.59) | 40,488.35 (25,595.87) | <0.001 | 43,796.39 (27,974.17) | |
Current residence, n (%) | Rural | 1490 (53.27) | 3383 (71.27) | <0.001 | 4873 (64.59) |
Urban | 1307 (46.73) | 1364 (28.73) | 2671 (35.41) | ||
Self-reported health status, n (%) | Poor | 1213 (43.38) | 2042 (43.02) | 0.070 | 3256 (43.15) |
Fair | 814 (29.11) | 1293 (27.24) | 2107 (27.93) | ||
Good | 769 (27.50) | 1412 (29.75) | 2181 (28.91) | ||
ADL limitations, n (%) | No | 2147 (76.76) | 3435 (72.36) | <0.001 | 5582 (73.99) |
Yes | 650 (23.24) | 1312 (27.64) | 1962 (26.01) | ||
IADL limitations, n (%) | No | 2014 (72.01) | 3297 (69.45) | 0.019 | 5311 (70.40) |
Yes | 783 (27.99) | 1450 (30.55) | 2233 (29.60) | ||
Depression, n (%) | No | 1598 (57.13) | 2371 (49.95) | <0.001 | 3969 (52.61) |
Yes | 1199 (42.87) | 2376 (50.05) | 3575 (47.39) | ||
Age group, n (%) | 45–49 | 224 (8.01) | 421 (8.87) | <0.001 | 645 (8.55) |
50–59 | 1032 (36.90) | 1534 (32.32) | 2566 (34.01) | ||
60–69 | 919 (32.86) | 1709 (36.00) | 2628 (34.84) | ||
70–79 | 502 (17.95) | 839 (17.67) | 1341 (17.78) | ||
≥80 | 120 (4.29) | 244 (5.14) | 364 (4.83) | ||
Age, mean (SD) | 61.85(9.55) | 62.35(9.56) | 0.029 | 62.17(9.56) | |
Sex, n (%) | Female | 1592 (56.92) | 2862 (60.29) | 0.004 | 4454 (59.04) |
Male | 1205 (43.08) | 1885 (39.71) | 3090 (40.96) | ||
Marital status, n (%) | Without spouse | 401 (14.34) | 792 (16.68) | 0.007 | 1193 (15.81) |
With spouse | 2396 (85.66) | 3955 (83.32) | 6351 (84.19) | ||
Education, n (%) | Elementary school and below | 1642 (58.71) | 3651 (76.91) | <0.001 | 5293 (70.16) |
Secondary school | 1042 (37.25) | 1067 (22.48) | 2109 (27.96) | ||
College and above | 113 (4.04) | 29 (0.61) | 142 (1.88) | ||
Work status, n (%) | Unemployed | 1139 (40.72) | 1681 (35.41) | <0.001 | 2820 (37.38) |
Employed | 1003 (35.86) | 2758 (58.10) | 3761 (49.85) | ||
Retired | 655 (23.42) | 308 (6.49) | 963 (12.77) | ||
Smoking, n (%) | Never | 1772 (63.35) | 3035 (63.94) | <0.001 | 4807 (63.72) |
Used to smoke | 450 (16.09) | 526 (11.08) | 976 (12.94) | ||
Now | 575 (20.56) | 1186 (24.98) | 1761 (23.34) | ||
Drinking, n (%) | Never | 2031 (72.61) | 3394 (71.50) | 0.158 | 5425 (71.91) |
<1 time per month | 219 (7.83) | 343 (7.23) | 562 (7.45) | ||
≥1 times per month | 547 (19.56) | 1010 (21.28) | 1557 (20.64) | ||
Number of chronic diseases, n (%) | 0 | 338 (12.08) | 753 (15.86) | <0.001 | 1091 (14.46) |
1 | 624 (22.31) | 1160 (24.44) | 1784 (23.65) | ||
≥2 | 1835 (65.61) | 2834 (59.70) | 4669 (61.89) | ||
Frequency of social activity, n (%) | None | 1164 (41.62) | 2126 (44.79) | 0.001 | 3290 (43.61) |
Not regular | 409 (14.62) | 736 (15.50) | 1145 (15.18) | ||
Almost every week | 327 (11.69) | 576 (12.13) | 903 (11.97) | ||
Almost every day | 897 (32.07) | 1309 (27.58) | 2206 (29.24) | ||
Medical insurance status, n (%) | None | 87 (3.11) | 160 (3.37) | <0.001 | 247 (3.27) |
Urban Employee Basic Medical Insurance | 562 (20.09) | 253 (5.33) | 815 (10.80) | ||
Urban and rural resident medical insurance | 2043 (73.04) | 4292 (90.41) | 6335 (83.97) | ||
other medical insurance | 105 (3.75) | 42 (0.88) | 147 (1.95) | ||
PCE/yuan, mean (SD) | 5439.45 (5044.94) | 3471.36 (3309.48) | 4201.05 (4150.81) | ||
ln PCE, mean (SD) | 8.24 (0.87) | 7.81 (0.82) | <0.001 | 7.97 (0.86) | |
Number of caregivers, n (%) | 0 | 2186 (78.16) | 3674 (77.40) | 0.620 | 5860 (77.68) |
1 | 259 (9.26) | 427 (9.00) | 686 (9.09) | ||
2–3 | 250 (8.94) | 452 (9.52) | 702 (9.31) | ||
≥4 | 102 (3.65) | 194 (4.09) | 296 (3.92) | ||
Living arrangement, n (%) | Alone | 275 (9.83) | 488 (10.28) | 0.027 | 763 (10.11) |
With relatives | 159 (5.68) | 350 (7.37) | 509 (6.75) | ||
With spouse | 1935 (69.18) | 3227 (67.98) | 5162 (68.43) | ||
With offspring | 428 (15.30) | 682 (14.37) | 1110 (14.71) |
The Total Number of Outpatient Visits = 1 (n = 3957) | The Total Number of Outpatient Visits = 2 (n = 1706) | The Total Number of Outpatient Visits ≥ 3 (n = 1881) | Overall (n = 7544) | |||||
---|---|---|---|---|---|---|---|---|
Hospital Outpatient Visits (n = 1754) | Primary Care Outpatient Visits (n = 2203) | Hospital Outpatient Visits (n = 573) | Primary Care Outpatient Visits (n = 1133) | Hospital Outpatient Visits (n = 470) | Primary Care Outpatient Visits (n = 1411) | Hospital Outpatient Visits (n = 2797) | Primary Care Outpatient Visits (n = 4747) | |
ER visits, n (%) | 137 *** (7.81) | 24 (1.09) | 31 *** (5.41) | 12 (1.06) | 24 *** (5.11) | 14 (0.99) | 192 *** (6.86) | 50 (1.05) |
Hospitalization, n (%) | 463 *** (26.40) | 325 (14.75) | 148 *** (25.83) | 187 (16.50) | 142*** (30.21) | 270 (19.14) | 753 *** (26.92) | 782 (16.47) |
Number of hospitalizations, mean (SD) | 0.41 *** (0.89) | 0.23 (0.68) | 0.47 *** (0.97) | 0.27 (0.76) | 0.56 *** (1.16) | 0.32 (0.86) | 0.45 *** (0.96) | 0.27 (0.76) |
Length of hospitalization in days, mean (SD) | 3.51 *** (8.96) | 1.52 (5.06) | 3.16 *** (7.20) | 1.70 (6.50) | 4.11 *** (9.61) | 2.01 (6.34) | 3.54 *** (8.75) | 1.73 (5.83) |
Outpatient Visit Types | ER Visits or Not n = 7544 | Hospitalization or Not n = 7544 | Number of Hospitalizations n = 1535 | Length of Hospitalization Days n = 1535 | ||||
---|---|---|---|---|---|---|---|---|
Adjusted OR (95% CI) | Average Marginal Effect (95% CI) | Adjusted OR (95% CI) | Average Marginal Effect (95% CI) | Adjusted IRR (95% CI) | Average Marginal Effect (95% CI) | Adjusted IRR (95% CI) | Average Marginal Effect (95% CI) | |
Ref: Hospital outpatient visits | ||||||||
Primary care outpatient visits | 0.141 *** (0.101, 0.194) | −0.058 *** (−0.069, −0.048) | 0.623 *** (0.546, 0.711) | -0.069 *** (−0.089, −0.049) | 0.961 (0.788,1.173) | −0.020 (−0.122, 0.081) | 0.886 ** (0.810, 0.969) | −1.407 ** (−2.450, −0.365) |
Outpatient Visit Types | ER Visits or Not a n = 7544 | Hospitalization or Not n = 7544 | Number of Hospitalizations b n = 1535 | Length of Hospitalization Days n = 1535 | ||||
---|---|---|---|---|---|---|---|---|
Adjusted OR (95% CI) | Average Marginal Effect (95% CI) | Adjusted OR (95% CI) | Average Marginal Effect (95% CI) | Adjusted IRR (95% CI) | Average Marginal Effect (95% CI) | Adjusted IRR (95% CI) | Average Marginal Effect (95% CI) | |
The total number of outpatient visits = 1 | n = 3957 | n = 788 | ||||||
Ref: Hospital outpatient visits | ||||||||
Primary care outpatient visits | 0.131 *** (0.084, 0.204) | −0.065 *** (−0.079, −0.052) | 0.577 *** (0.481, 0.692) | −0.076 *** (−0.101, −0.051) | 1.096 (0.871, 1.380) | 0.086 (−0.132, 0.305) | 0.828 ** (0.740, 0.927) | −2.199 ** (−3.503, −0.896) |
The total number of outpatient visits = 2 | n = 1706 | n = 335 | ||||||
Ref: Hospital outpatient visits | ||||||||
Primary care outpatient visits | 0.154 *** (0.073, 0.327) | −0.048 *** (−0.070, −0.026) | 0.724 * (0.547, 0.958) | −0.046 *** (−0.086, −0.005) | 0.821 (0.591, 1.140) | −0.200 (−0.532, 0.132) | 0.967 (0.806, 1.160) | −0.371 (−2.353, 1.611) |
The total number of outpatient visits ≥ 3 | n = 1881 | n = 412 | ||||||
Ref: Hospital outpatient visits | ||||||||
Primary care outpatient visits | 0.173 *** (0.083, 0.359) | −0.042 *** (−0.063, −0.020) | 0.684 * (0.506, 0.923) | −0.059 *** (−0.107, −0.011) | 0.733 (0.511, 1.053) | −0.263 (−0.595, 0.069) | 0.974 (0.834, 1.137) | −0.312 (−2.140, 1.515) |
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Yang, S.; Zhou, M.; Liao, J.; Ding, X.; Hu, N.; Kuang, L. Association between Primary Care Utilization and Emergency Room or Hospital Inpatient Services Utilization among the Middle-Aged and Elderly in a Self-Referral System: Evidence from the China Health and Retirement Longitudinal Study 2011–2018. Int. J. Environ. Res. Public Health 2022, 19, 12979. https://doi.org/10.3390/ijerph191912979
Yang S, Zhou M, Liao J, Ding X, Hu N, Kuang L. Association between Primary Care Utilization and Emergency Room or Hospital Inpatient Services Utilization among the Middle-Aged and Elderly in a Self-Referral System: Evidence from the China Health and Retirement Longitudinal Study 2011–2018. International Journal of Environmental Research and Public Health. 2022; 19(19):12979. https://doi.org/10.3390/ijerph191912979
Chicago/Turabian StyleYang, Siman, Mengping Zhou, Jingyi Liao, Xinxin Ding, Nan Hu, and Li Kuang. 2022. "Association between Primary Care Utilization and Emergency Room or Hospital Inpatient Services Utilization among the Middle-Aged and Elderly in a Self-Referral System: Evidence from the China Health and Retirement Longitudinal Study 2011–2018" International Journal of Environmental Research and Public Health 19, no. 19: 12979. https://doi.org/10.3390/ijerph191912979