Abstract P086: Sex-specific Differences in Psychosocial and Other Determinants Predicting Hospital Utilization in Older Adults
Background: Hospital utilization is common and costly in the elderly, and rates differ by sex. Few data are available regarding sex-specific determinants of hospital utilization.
Methods: Using longitudinal data from the Cohort Study of Medication Adherence in Older Adults (CoSMO), all-cause hospitalizations were captured over 3 years. Subjects were classified as not hospitalized, hospitalized and not readmitted, and hospitalized and readmitted within 12 months. Comprehensive data on psychosocial, clinical, healthcare and behavioral risk factors were assessed at baseline using data from validated surveys and healthcare utilization databases. Sex-stratified generalized logit models were used to identify baseline risk factors predictive of hospital admission and readmission.
Results: Of the 1981 subjects included in this analysis, 48.8% were >75 years old, 58.9% were female, 30.5% were black, 79.1% had high school education or more, and 62.8% had hypertension duration for 10 or more years. Over 3 years, 508 (25.6%) were hospitalized but not readmitted and 262 (13.2%) were hospitalized and readmitted within 12 months; women versus men were less likely to be hospitalized (P<0.001). After multivariable adjustment, the factors associated with hospital readmission versus no hospitalization in men were hypertension duration ≥10 years (Odds ratio-OR 1.76 (95% confidence interval -CI 1.04, 2.97), Charlson comorbidity score ≥2 (OR 6.51 (95% CI 3.52, 12.06), 4 or more clinic visits/ year (OR 2.19 (1.33, 3.61); low sexual functioning (OR 1.71 (95% CI 1.03, 2.84), reducing salt to control blood pressure (OR 2.12 (95% CI 1.12, 4.01), low social support (OR 0.26 (95% CI 0.26, 0.82), and being married (OR 0.32 (95% CI 0.17, 0.61). In women, the factors associated with hospital readmission versus no hospitalization were Charlson comorbidity score ≥2 (OR 4.41 (95% CI 2.78, 6.99) and low overall satisfaction with healthcare (OR 4.85 (95% CI 1.93, 12.19). Results were qualitatively similar for men and women who were hospitalized but not readmitted.
Conclusions: Sex-specific differences in psychosocial and other determinants predicting hospital use over 3 years were identified. Further research is needed in larger samples to explore the influence of change in key individual factors on hospital utilization over time.
Author Disclosures: M. Krousel-Wood: None. C. Joyce: None. P. Oravetz: None. J. Niles: None. D.J. Graziano: None. L.O. Hansen: None. B. Spring: None. G. Graham: None. C. Macal: None.
- © 2015 by American Heart Association, Inc.