Do men avoid seeking medical advice? A register-based analysis of gender-specific changes in primary healthcare use after first hospitalisation at ages 60+ in Denmark

Höhn, A. , Gampe, J., Lindahl-Jacobsen, R., Christensen, K. and Oksuyzan, A. (2020) Do men avoid seeking medical advice? A register-based analysis of gender-specific changes in primary healthcare use after first hospitalisation at ages 60+ in Denmark. Journal of Epidemiology and Community Health, 74(7), pp. 573-579. (doi: 10.1136/jech-2019-213435) (PMID:32303595) (PMCID:PMC7337231)

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Abstract

Background: It remains unclear whether women’s greater primary healthcare use reflects a lower treatment-seeking threshold or a health disadvantage. We address this question by studying primary healthcare use surrounding a major health shock. Methods: This cohort study utilises routinely-collected healthcare data covering the Danish population aged 60+ years between 1996 and 2011. Using a hurdle model, we investigate levels of non-use and levels of primary healthcare use before and after first inpatient hospitalisation for stroke, myocardial infarction (MI), chronic obstructive pulmonary disease (COPD) and gastrointestinal cancers (GIC). Results: Before hospitalisation, irrespective of cause, men were more likely than women to be non-users of primary healthcare (OR (95% CI): stroke 1.802 (1.731 to 1.872); MI 1.841 (1.760 to 1.922); COPD 2.160 (2.028 to 2.292); GIC 1.609 (1.525 to 1.693)). Men who were users had fewer primary healthcare contacts than women (proportional change (eβ) (95% CI): stroke 0.821 (0.806 to 0.836); MI 0.796 (0.778 to 0.814); COPD 0.855 (0.832 to 0.878); GIC 0.859 (0.838 to 0.881)). Following hospitalisation, changes in the probability of being a non-user (OR (95% CI): stroke 0.965 (0.879 to 1.052); MI 0.894 (0.789 to 0.999); COPD 0.755 (0.609 to 0.900); GIC 0.895 (0.801 to 0.988)) and levels of primary healthcare use (eβ (95% CI): stroke 1.113 (1.102 to 1.124); MI 1.112 (1.099 to 1.124); COPD 1.078 (1.063 to 1.093); GIC 1.097 (1.079 to 1.114)) were more pronounced among men. Gender differences widened after accounting for survival following hospitalisation. Conclusion: Women’s consistently higher levels of primary healthcare use are likely to be explained by a combination of a lower treatment-seeking threshold and a health disadvantage resulting from better survival in bad health.

Item Type:Articles
Additional Information:Funding: The work was supported by the US National Institute of Health (P01AG031719, R01AG026786, and 2P01AG031719), the VELUX Foundation and the Max Planck Society within the framework of the project “On the edge of societies: New vulnerable populations, emerging challenges for social policies and future demands for social innovation. The experience of the Baltic Sea States (2016-2021)”.
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Hoehn, Dr Andreas
Authors: Höhn, A., Gampe, J., Lindahl-Jacobsen, R., Christensen, K., and Oksuyzan, A.
College/School:College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > MRC/CSO SPHSU
Journal Name:Journal of Epidemiology and Community Health
Publisher:BMJ Publishing Group
ISSN:0143-005X
ISSN (Online):1470-2738
Published Online:17 April 2020
Copyright Holders:Copyright © Author(s) (or their employer(s)) 2020
First Published:First published in Journal of Epidemiology and Community Health 74(7): 573-579
Publisher Policy:Reproduced under a Creative Commons licence

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