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Influence of health-related quality of life on health service utilization in addition to socio-demographic and morbidity variables among primary care patients in China

  • Original Article
  • Published:
International Journal of Public Health

Abstract

Objectives

We aimed to investigate whether health-related quality of life (HRQOL) influences health service utilization and whether such influence exists independently in addition to socio-demographic and morbidity variables.

Methods

A retrospective design was carried out among 737 primary care patients in mainland China. Health service utilization was measured by the number of monthly outpatient consultations and the annual hospitalization rate. HRQOL was measured by the SF-36. A clustered regression model was adopted throughout the analysis.

Results

Lower HRQOL was associated with a higher utilization rate. Three out of the eight SF-36 subscales were associated with outpatient consultation, and additional two with inpatient consultation. One subscale of the SF-36 (mental health) was associated with an independent influence of 11.8% with outpatient consultation, and another subscale of the SF-36 (general health) was associated with an independent influence of 26.0% with inpatient consultation.

Conclusions

Health service utilization increased significantly with decreasing HRQOL, and the independent influence of HRQOL on health service utilization was smaller than that of socio-demographic and morbidity variables among primary care patients in mainland China.

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References

  • Andersen R, Newman JF (1973) Societal and individual determinants of medical care utilization in the United States. Milbank Mem Fund Q Health Soc 51:95–124

    Article  CAS  PubMed  Google Scholar 

  • Berra S, Borrell C, Rajmil L, Estrada MD, Rodríguez M, Riley AW, Forrest CB, Starfield B (2006) Perceived health status and use of healthcare services among children and adolescents. Eur J Public Health 16:405–414

    Article  PubMed  Google Scholar 

  • Chen TH, Li L (2005) A systematic review: how to choose appropriate health-related quality of life (HRQOL) measures in routine general practice? J Zhejiang Univ Sci B 6:936–940

    Article  PubMed  Google Scholar 

  • Chen TH, Li L, Sigle JM, Du YP, Wang HM, Lei J (2007) Crossover randomized controlled trial of the electronic version of the Chinese SF-36. J Zhejiang Univ Sci B 8:604–608

    Article  PubMed  Google Scholar 

  • Cohen YC, Rubin HR, Freedman L, Mozes B (1999) Use of a clustered model to identify factors affecting hospital length of stay. J Clin Epidemiol 52:1031–1036

    Article  CAS  PubMed  Google Scholar 

  • de Boer AG, Wijker W, de Haes HC (1997) Predictors of health care utilization in the chronically ill: a review of the literature. Health Policy 42:101–115

    Article  PubMed  Google Scholar 

  • Dominick KL, Ahern FM, Gold CH, Heller DA (2004) Health-related quality of life and health service use among older adults with osteoarthritis. Arthritis Rheum 51:326–331

    Article  PubMed  Google Scholar 

  • Dunlop S, Coyte PC, McIsaac W (2000) Socio-economic status and the utilisation of physicians’ services: results from the Canadian National Population Health Survey. Soc Sci Med 51:123–133

    Article  CAS  PubMed  Google Scholar 

  • Ethgen O, Kahler KH, Kong SX, Reginster JY, Wolfe F (2002) The effect of health-related quality of life on reported use of health-care resources in patients with osteoarthritis and rheumatoid arthritis: a longitudinal analysis. J Rheumatol 29:1147–1155

    PubMed  Google Scholar 

  • Fuh JL, Wang SJ, Lu SR, Juang KD, Lee SJ (2000) Psychometric evaluation of a Chinese (Taiwanese) version of the SF-36 health survey amongst middle-aged women from a rural community. Qual Life Res 9:675–683

    Article  CAS  PubMed  Google Scholar 

  • Hornbrook MC, Goodman MJ (1996) Chronic disease, functional health status, and demographics: a multi-dimensional approach to risk adjustment. Health Serv Res 31:283–307

    CAS  PubMed  Google Scholar 

  • Lam CL, Gandek B, Ren XS, Chan MS (1998) Tests of scaling assumptions and construct validity of the Chinese (HK) version of the SF-36 Health Survey. J Clin Epidemiol 51:1139–1147

    Article  CAS  PubMed  Google Scholar 

  • Lam CL, Fong DY, Lauder IJ, Lam TP (2002) The effect of health-related quality of life (HRQOL) on health service utilization of a Chinese population. Soc Sci Med 55:1635–1646

    Article  PubMed  Google Scholar 

  • Li L, Wang HM, Shen Y (2003) Chinese SF-36 health survey: translation, cultural adaptation, validation, and normalisation. J Epidemiol Community Health 57:259–263

    Article  CAS  PubMed  Google Scholar 

  • Matsumura S, Bito S, Fukuhara S (2000) Perceived health status as a predictor of utilization of health-care resources and the number of sick-leave days in Japan. In: “Abstracts of selected papers from the 1st pan-Pacific conference of the international society for quality of life research (ISOQOL), 13–15 April 2001, Tokyo, Japan”. Qual Life Res 9:1063

  • Miilunpalo S, Vuori I, Oja P, Pasanen M, Urponen H (1997) Self-rated health status as a health measure: the predictive value of self-reported health status on the use of physician services and on mortality in the working-age population. J Clin Epidemiol 50:517–528

    Article  CAS  PubMed  Google Scholar 

  • Mols F, Coebergh JW, van de Poll-Franse LV (2007) Health-related quality of life and health care utilisation among older long-term cancer survivors: a population-based study. Eur J Cancer 43:2211–2221

    Article  PubMed  Google Scholar 

  • Nelson EC, McHorney CA, Manning WG Jr, Rogers WH, Zubkoff M, Greenfield S, Ware JE Jr, Tarlov AR (1998) A longitudinal study of hospitalization rates for patients with chronic disease: results from the medical outcomes study. Health Serv Res 32:759–774

    CAS  PubMed  Google Scholar 

  • Rosemann T, Grol R, Herman K, Wensing M, Szecsenyi J (2008) Association between obesity, quality of life, physical activity and health service utilization in primary care patients with osteoarthritis. Int J Behav Nutr Phys Act 5:4

    Article  PubMed  Google Scholar 

  • Sigle J, Porzsolt F (1996) Practical aspects of quality-of-life measurement: design and feasibility study of the quality-of-life recorder and the standardized measurement of quality of life in an outpatient clinic. Cancer Treat Rev 22(Suppl A):75–89

    Article  PubMed  Google Scholar 

  • Singh JA, Nelson DB, Fink HA, Nichol KL (2005) Health-related quality of life predicts future health-care utilization and mortality in veterans with self-reported physician-diagnosed arthritis: the veterans arthritis quality of life study. Semin Arthritis Rheum 34:755–765

    Article  PubMed  Google Scholar 

  • Sutton M, Carr-Hill R, Gravelle H, Rice N (1999) Do measures of self-reported morbidity bias the estimation of the determinants of health care utilisation? Soc Sci Med 49:867–878

    Article  CAS  PubMed  Google Scholar 

  • Wang W, Lopez V, Ying CS, Thompson DR (2006) The psychometric properties of the Chinese version of the SF-36 health survey in patients with myocardial infarction in mainland China. Qual Life Res 15:1525–1531

    Article  PubMed  Google Scholar 

  • Ware JE Jr (2000) SF-36 health survey update. Spine 25:3130–3139

    Article  PubMed  Google Scholar 

  • Ware JE Jr, Gandek B (1998) Overview of the SF-36 health survey and the international quality of life assessment (IQOLA) project. J Clin Epidemiol 51:903–912

    Article  PubMed  Google Scholar 

  • Ware JE Jr, Sherbourne CD (1992) The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care 30:473–483

    Article  PubMed  Google Scholar 

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Acknowledgments

This study was supported by the project (grant # WKJ2006-2-016) entitled ‘Effect of chronic diseases and health-related quality of life on health service utilization’ of the Ministry of Health, China. We are deeply indebted to Dr. Joerg M. Sigle for his kind support. We strongly appreciate the great help from the two anonymous reviewers in the form of critical comments and constructive suggestions.

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Authors and Affiliations

  1. Institute of Social and Family Medicine, Zhejiang University, Zijingang Campus, Mailbox 25, No. 388, Yuhangtan Road, 310058, Hangzhou, China

    Tianhui Chen & Lu Li

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  1. Tianhui Chen
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  2. Lu Li
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Correspondence to Lu Li.

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Chen, T., Li, L. Influence of health-related quality of life on health service utilization in addition to socio-demographic and morbidity variables among primary care patients in China. Int J Public Health 54, 325–332 (2009). https://doi.org/10.1007/s00038-009-0057-3

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  • DOI: https://doi.org/10.1007/s00038-009-0057-3

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