Health services use and health status among people with diabetes mellitus and cardiovascular diseases

In the United States, Diabetes Mellitus (DM) becomes an important public health issue and has a great impact on health care costs. Diabetic patients are at a higher risk of developing cardiovascular diseases (CVD) compared to people without DM. This study adopted the Andersen's Behavioral Model of Health Services Utilization as a framework to examine health services uses and to further identify the association of health services uses and subsequent health outcomes within a representative sample of community-dwelling adults aged 51 years and older through a longitudinal analysis of the Health and Retirement Study data from 1998 through 2008. Results showed that less discretionary health services use (hospitalization and home health care) was more likely to be influenced by need factors. More discretionary health services use (doctor visits) was more likely to be influenced by predisposing factors. Although most health services uses were associated with worse or declined status in activities of daily living (ADL), instrumental activities of daily living (IADL), or self-rated health, certain health services use were found to be associated with less worse or not declined health status. The use of outpatient surgery among people with CVD only and the use of home health care among people with DM and CVD were associated with not declined IADL and self-rated health, respectively. In addition, the association between nursing home care and ADL, prescription drug use and IADL, and home health care and self-rated health was found to be different by health groups. Most health services uses were associated with higher risk of 10-year mortality. People with DM and CVD had the greater hazard to death compared with people with DM only. The association between mortality and doctor visits after baseline, and hospitalizations after baseline was different by health groups. Our study findings can provide health care professionals and health care administrators the insight required for improving the health care practice and the quality of health care in the U.S.

Mortality

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