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.
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Contributors AH, JG, RL-J, KC and AO designed the study. AH analysed the data. JG provided support with statistical programming. AH, JG, RL-J, KC and AO interpreted and discussed the results and implications. AH wrote the paper. All authors contributed to the revision of the paper and have approved the final version.
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)”. The funders had no role in the design of the study or in the collection, analysis, and interpretation of data and results.
Competing interests None declared.
Patient consent for publication Not required.
Ethics approval The study involves secondary data analysis of existing register data. The project was approved by the ethical committee assigned through the Danish National Committee on Biomedical Research and the Danish Data Protection Agency.
Data sharing statement Data may be obtained from a third party and are not publicly available.
Provenance and peer review Not commissioned; externally peer reviewed.
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