Hospitalization in older adults: association with multimorbidity, primary health care and private health plan

Nunes, Bruno Pereira; Soares, Mariangela Uhlmann; Wachs, Louriele Soares; Volz, Pâmela Moraes; Saes, Mirelle de Oliveira; Duro, Suele Manjourany Silva; Thumé, Elaine; Facchini, Luiz Augusto

doi:10.1590/S1518-8787.2017051006646

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Original Articles • Rev. Saúde Pública 51 • 2017 • https://doi.org/10.1590/S1518-8787.2017051006646 copy

Hospitalization in older adults: association with multimorbidity, primary health care and private health plan

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

OBJECTIVE

Evaluate the association of multimorbidity, primary health care model and possession of a private health plan with hospitalization.

METHODS

A population-based cross-sectional study with 1,593 elderly individuals (60 years old or older) living in the urban area of the city of Bagé, State of Rio Grande do Sul, Brazil. The outcome was hospitalization in the year preceding the interview. The multimorbidity was evaluated through two cut-off points (≥ 2 and ≥ 3). The primary health care model was defined by residence in areas covered by traditional care or by Family Health Strategy. The older adults mentioned the possession of a private health plan. We performed a gross and adjusted analysis by Poisson regression using a hierarchical model. The adjustment included demographic, socioeconomic, functional capacity disability and health services variables.

RESULTS

The occurrence of overall and non-surgical hospitalization was 17.7% (95%CI 15.8–19.6) and 10.6% (95%CI 9.1–12.1), respectively. Older adults with multimorbidity were admitted to hospitals more often when to older adults without multimorbidity, regardless of the exhibition’ form of operation. Having a private health plan increased the hospitalization by 1.71 (95%CI 1.09–2.69) times among residents in the areas of the Family Health Strategy when compared to elderly residents in traditional areas without a private health plan.

CONCLUSIONS

The multimorbidity increased the occurrence of hospitalizations, especially non-surgical ones. Hospitalization was more frequent in older adults with private health plan and those living in Family Health Strategy areas, regardless of the presence of multiple diseases.

Aged; Comorbidity; Hospitalization; Prepaid health care plans; Family Health Strategy

Variable	Sample		Multimorbidity (≥ 2)	Multimorbidity (≥ 3)	Hospitalization	Non-surgical hospitalization

	n	%	% (95%CI)	% (95%CI)	% (95%CI)	% (95%CI)
Gender
Male	593	37.2	67.3 (63.4–71.3)	45.9 (41.7–50.1)	18.4 (15.3–21.5)	10.6 (8.1–13.1)
Female	1,000	62.8	82.1 (80.0–84.6)	65.3 (62.3–68.4)	17.3 (15.0–19.6)	10.6 (8.7–12.5)
Skin color
White	1,252	78.6	74.7 (72.2–77.2)	55.1 (52.2–57.9)	18.2 (16.1–20.4)	10.4 (8.7–12.1)
Black	139	8.7	79.8 (72.7–86.9)	68.5 (60.3–76.8)	18.0 (11.6–24.4)	13.8 (8.0–19.5)
Brown/Yellow/Indigenous	202	12.7	86.2 (81.3–91.2)	70.4 (63.8–76.9)	14.4 (9.5–19.2)	10.1 (5.9–14.2)
Age (in completed years)
60–64	400	25.1	72.4 (68.0–77.0)	52.0 (46.9–57.0)	14.3 (10.9–17.7)	8.4 (5.6–11.1)
65–69	374	23.5	72.1 (67.5–76.8)	55.4 (50.3–60.6)	15.8 (12.1–19.5)	7.5 (4.8–10.2)
70–74	322	20.2	77.7 (73.0–82.5)	57.8 (52.2–63.4)	19.9 (15.5–24.3)	10.7 (7.2–14.1)
≥ 75	497	31.2	83.3 (79.8–86.8)	66.1 (61.6–70.5)	20.5 (17.0–24.1)	14.8 (11.6–17.9)
Marital status
Married or common-law	816	51.2	80.2 (77.4–83.0)	61.8 (58.4–65.2)	18.2 (15.5–20.8)	10.3 (8.2–12.4)
Single or divorced	238	15.0	79.3 (73.9–84.8)	60.6 (54.0–67.1)	16.8 (12.0–21.6)	10.2 (6.3–14.0)
Widowed	538	33.8	83.9 (80.6–87.1)	68.8 (64.7–72.9)	17.5 (14.3–20.7)	11.4 (8.7–14.1)
Retired
No	451	28.3	81.9 (78.2–85.6)	65.5 (60.9–70.0)	15.1 (11.8–18.4)	9.1 (6.4–11.8)
Yes	1,142	71.7	81.1 (78.7–83.4)	63.4 (60.4–66.3)	18.8 (16.5–21.0)	11.2 (9.4–13.1)
Education (in complete years)
None	372	23.7	87.1 (83.5–90.7)	72.1 (67.4–76.9)	16.9 (13.1–20.8)	11.4 (8.1–14.6)
1–7	858	54.5	76.9 (74.0–79.9)	57.3 (53.8–60.7)	18.7 (16.1–21.3)	10.3 (8.2–12.3)
≥ 8	342	21.8	64.8 (59.5–70.0)	45.3 (39.8–50.8)	16.7 (12.7–20.6)	10.7 (7.4–14.0)
Economic classification
A or B (richest)	429	27.1	69.1 (64.6–73.7)	51.3 (46.3–56.2)	18.5 (14.8–22.1)	10.1 (7.2–13.0)
C	615	38.9	75.1 (71.6–78.7)	55.7 (51.6–59.8)	17.9 (14.9–20.9)	11.1 (8.6–13.6)
D or E	537	34.0	84.0 (80.8–87.2)	66.1 (62.0–70.3)	17.1 (13.9–20.3)	10.6 (7.9–13.2)
Functional disability for AVD
No	1,424	89.4	80.1 (78.0–82.2)	61.8 (59.2–64.3)	15.5 (13.6–17.3)	8.5 (7.0–9.9)
Yes	169	10.6	96.3 (92.7–99.9)	91.7 (86.4–96.9)	36.7 (29.4–44.0)	29.3 (22.3–36.3)
Functional disability for AIVD
No	1,045	65.8	76.8 (74.1–79.4)	55.7 (52.6–58.7)	13.0 (11.0–15.1)	6.5 (5.0–8.0)
Yes	544	34.2	91.7 (89.2–94.2)	82.9 (79.5–86.4)	26.8 (23.1–30.6)	18.8 (15.5–22.1)
Private health plan
No	1,025	64.6	82.8 (80.4–85.2)	65.6 (62.6–68.7)	16.1 (13.9–18.4)	9.8 (7.9–11.6)
Yes	561	35.4	78.8 (75.3–82.2)	61.3 (57.1–65.4)	20.3 (17.0–23.7)	11.8 (9.1–14.4)
Primary health care model
Traditional	741	46.5	77.9 (74.8–81.1)	59.7 (56.0–63.4)	17.3 (14.5–20.0)	9.6 (7.4–11.7)
FHS	852	53.5	84.2 (81.6–86.7)	67.6 (64.3–70.8)	18.1 (15.5–20.7)	11.5 (9.4–13.7)
Home care
No	1,482	93.1	80.4 (78.3–82.4)	62.3 (59.7–64.8)	15.8 (13.9–17.7)	9.0 (7.5–10.5)
Yes	109	6.9	96.5 (92.5–100)	90.6 (84.3–96.8)	43.1 (33.8–52.5)	32.4 (23.4–41.4)
Total	1,593	100	81.3 (79.3–83.3)	64.0 (61.5–66.4)	17.7 (15.8–19.6)	10.6 (9.1–12.1)

Variable	Hospitalization		Non-surgical hospitalization

	Gross analysis	Adjusted analysis^c	Gross analysis	Adjusted analysis^c

	PR (95%CI)	PR (95%CI)	PR (95%CI)	PR (95%CI)
Multimorbidity (≥ 2)^a	p = 0.003	p = 0.003	p = 0.003	p = 0.003
No	1	1	1	1
Yes	1.73 (1.21–2.47)	1.75 (1.21–2.51)	2.35 (1.35–4.09)	2.34 (1.34–4.08)
Multimorbidity (≥ 3)^b	p < 0.001	p < 0.001	p < 0.001	p < 0.001
No	1	1	1	1
Yes	1.83 (1.40–2.40)	1.94 (1.46–2.56)	2.87 (1.88–4.39)	3.10 (2.01–4.80)
Primary health care model/Possession of a private health plan	p = 0.002	p = 0.011	p = 0.002	p = 0.021
Traditional/No plan	1	1	1	1
Traditional/With plan	0.92 (0.67–1.27)	1.01 (0.71–1.42)	0.74 (0.46–1.17)	0.84 (0.50–1.39)
FHS/Without plan	0.84 (0.64–1.12)	0.80 (0.58–1.09)	0.85 (0.59–1.24)	0.80 (0.51–1.21)
FHS/With plan	1.89 (1.23–2.91)	1.68 (1.07–2.64)	2.60 (1.43–4.74)	2.20 (1.16–4.19)

Socioeconomic and health condition variables	Traditional		FHS

	No plan	With plan	No plan	With plan
Economic classification
A or B (richest)	21.8	54.1	10.2	43.6
C	42.4	36.6	37.9	38.7
D or E	35.7	9.3	51.9	17.8
Education (in complete years)
None	19.4	9.6	36.1	19.0
1–7	60.0	44.2	56.5	55.3
≥ 8	20.6	46.2	7.5	25.7
Multimorbidity (≥ 2)	80.8	74.8	84.0	84.4
Multimorbidity (≥ 3)	63.6	55.4	67.0	69.7
AVD	8.4	9.9	12.2	11.1
AIVD	29.7	28.4	39.0	37.8

Faculdade de Saúde Pública da Universidade de São Paulo Avenida Dr. Arnaldo, 715, 01246-904 São Paulo SP Brazil, Tel./Fax: +55 11 3061-7985 - São Paulo - SP - Brazil
E-mail: revsp@usp.br

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[1] Correspondence: Bruno P Nunes. Faculdade Enfermagem – UFPel Rua Gomes Carneiro, 1 Centro 96010-610 Pelotas, RS, Brasil