Hypertension, diabetes, hypercholesterolemia, and their combinations increased health care utilization and decreased health status

doi:10.1016/j.jclinepi.2004.01.011

Journal of Clinical Epidemiology

Volume 57, Issue 9, September 2004, Pages 954-961

https://doi.org/10.1016/j.jclinepi.2004.01.011 Get rights and content

Abstract

Background and objective

For individuals with hypertension, diabetes, or hypercholesterolemia, the relative magnitude of cardiovascular risk factors and the effect of multiple risk factors remains controversial and both treatment practices and health care usage vary. We sought to determine the effect of hypertension, diabetes, hypercholesterolemia, and their combinations on health care utilization and health status through analysis of data from a large national survey.

Methods

We applied the Anderson model to a cross-sectional representative sample (n = 15,107) of the U.S. civilian, noninstitutionalized population (the 1996 Medical Expenditure Panel Survey).

Results

For diabetes, additional risk factors did not increase the likelihood of emergency room (ER) visits or hospitalizations but were associated with increased outpatient visits and poorer health status. For hypertension, additional risk factors increased the likelihood of hospitalization (but not ER visits), the number of outpatient visits, and poorer health status. For hypercholesterolemia, additional risk factors were associated with increased likelihood of ER visits, hospitalizations, and poorer health status but not more outpatient visits. Diabetes had the largest effect on health care utilization and health status.

Conclusion

These findings re-emphasize the magnitude of diabetes as a major risk factor associated with increased ER visits, hospitalizations, outpatients visits, and lower health status.

Introduction

Despite current efforts, individuals with hypertension, hypercholesterolemia and diabetes continue to have cardiovascular outcomes at high rates. Because there is controversy regarding the relative magnitude of different cardiovascular risk factors and the effect of multiple risk factors in the same individual [1], [2], and because the best approach to treating patients with multiple risk factors has not been enunciated, there is considerable variation in health care use. Sociodemographic characteristics, comorbidities, and perceived health status predict individual health care utilization [3]. The amount of acute health care utilization and routine health care may provide information regarding the effectiveness of current management strategies and provide baseline data against which future changes in intensity of management can be compared.

The Anderson model [4] is a patient-based behavioral model that links demographic, socioeconomic, ecological, need, and social-psychological variables to measures of health care utilization. It postulates that health care utilization is determined by need factors (illness-related factors), enabling factors (socioeconomic factors, insurance), and predisposing factors (age, sex, race, social class). Prior studies have shown that need variables such as self-reported illness and health status predict health care utilization but the other constructs of the model do not [5], [6].

The present analysis provides data regarding health care utilization and health status among individuals with known cardiovascular risk factors determined by applying the Anderson model of health care utilization to data from a large national survey. In this study we evaluated the effect of multiple cardiovascular risk factors in the same individual on health care utilization and health status and tested the hypothesis that multiple cardiovascular risk factors are associated with greater health care utilization and lower health status.

Section snippets

Research design and methods

This study is a cross-sectional analysis of the civilian, noninstitutionalized participants from the 1996 Medical Expenditure Panel Survey.

Patient characteristics

The study sample was 15,107 adults, which represents a population estimate of 194,600,000. This population was 48% male, 17% elderly (⩾65 years), 83% Caucasian; 18% had <12 years of education, 67% were employed, 14% had U.S. military service, and 79% had a usual source of healthcare. The number of individuals with the risk factors of interest was 2,126 for hypertension (population estimate 26,808,749), 609 for hypercholesterolemia (population 8,077,192), and 802 for diabetes (population

Discussion

Among the CVD risk factors evaluated, diabetes had the largest effect on healthcare utilization and health status, being associated with greater likelihood of ER visits, hospitalizations, and poorer health status, as well as more outpatient visits. Although risk factors in addition to diabetes did not increase the likelihood of ER visits or hospitalizations, additional risk factors were associated with more outpatient visits and poorer health status. Individuals with hypertension alone were

Acknowledgments

The authors thank John A. Colwell, MD, PhD, Kathryn M. Magruder, PhD, and Youlian Liao, MD, for reviewing earlier drafts of this manuscript. The authors also thank the Agency for Health Research and Quality for the Medical Expenditure Panel Survey data.

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: The views expressed in this article are those of the authors and do not necessarily reflect those of this agency. Grant support was provided, in part, by the Department of Veterans Affairs Health Services Research and Development Career Development Award RCD 000211 (to S.N.).

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Original ArticleHypertension, diabetes, hypercholesterolemia, and their combinations increased health care utilization and decreased health status

Abstract

Background and objective

Methods

Results

Conclusion

Introduction

Section snippets

Research design and methods

Patient characteristics

Discussion

Acknowledgments

J Clin Epidemiol

J Clin Epidemiol

Soc Sci Med

Soc Sci Med

Soc Sci Med

Am J Prev Med

Chronic disease, functional health status, and demographics: a multi-dimensional approach to risk adjustment

Health Serv Res

Choice of medical care: a behavioral model of health and illness behavior

J Health Soc Behav

Factors explaining the use of health care services by the elderly

Health Serv Res

Patterns of utilization: the patient perspective

Med Care

The Medical Expenditure Panel Survey: a national health information resource

Inquiry

Sample design of the 1996 Medical Expenditure Panel Survey Household Component. MEPS Methodology Report No. 2 (AHRQ Pub. No. 97–0027)

Estimation procedures in the 1996 Medical Expenditure Panel Survey Household Component. MEPS Methodology Report No. 5 (AHRQ Pub. No. 99–0027)

MEPS HC-006: 1996 Medical Conditions [CD-ROM]

Use of Health Care Services, 1996. MEPS Research Findings No. 7 (AHRQ Pub. No. 99-0018)

Health status and limitations: a comparison of hispanics, blacks, and whites, 1996. MEPS Research Findings No. 10 (AHRQ Pub. No. 00-0001)

SUDAAN user's manual, release 7.5

Original Article
Hypertension, diabetes, hypercholesterolemia, and their combinations increased health care utilization and decreased health status