Differences in healthcare service utilisation in elderly, registered in eight districts of five European countries.

AIMS: The aim of the study was to compare and analyse the differences in self-reported frequencies of visits paid to physicians and hospitalisation rates, as well as their association with socio-demographic factors and health status self-rated by elderly. METHODS: A cross-sectional study was performed in eight districts of five European countries (Finland, Sweden, Ireland, Croatia, and Greece). A total of 3540 persons aged 70 or more were interviewed by trained interviewers. Healthcare service utilisation and its association with demographic characteristics and self-rated health were analysed using descriptive statistical methods, chi-square test, and logistic regression. RESULTS: Almost 90% of elderly visited a physician in the past year; 50% visited a specialist, while 24% were hospitalised. A visit to a specialist was paid by 70% of the Greek, 50% to 60% of the Croatian, and around 40% of the Irish, the Finnish, and the Swedish elderly. The highest proportion of hospitalisations (32%) was encountered in Greece and the lowest one (20%) in Sweden. Self-rated poor health appears to be the only common denominator associated with increased healthcare utilisation. Younger age stood out as a statistically significant predictor of the likelihood of specialist consults, while older age, male gender, and the synergy of male gender and current single life were disclosed as the predictors of hospitalisation frequency. CONCLUSIONS: Healthcare service utilisation exercised by the elderly across European districts was found to be highly variable and showed a clear distinction between north-western and south-eastern Europe; this is in line with differences in self-rated health.

Place of residence as a correlate of sickness absence in Sweden.

A postal questionnaire was sent to 1500 randomly selected men and women aged 20-64 years living in three sparsely populated municipalities in northern Sweden with high rates of sickness absence, and to 1000 corresponding inhabitants in the Swedish capital Stockholm with a low rate of sickness absence. The proportion of participants aged >or=45 years was higher and incomes were lower in municipalities with high rates of sickness absence. In multiple logistic regression analyses with age, education, income, somatic health, mental health, pain and place of residence as independent variables, significant correlates of sick listing in men were: age >or=45 years (odds ratio 5.0; 95% confidence interval 2.4-10.3), poor somatic health (5.4; 2.6-11.0) and severe musculoskeletal pain (4.7; 2.4-9.1); and in women: age >or=45 years (2.6; 1.5-4.8), poor somatic health (12.2; 6.1-24.4), poor mental health (4.5; 2.0-10.1) and severe musculoskeletal pain (5.4; 2.7-10.5). Mental health was deleted by the logistic model for men, and income, education and place of residence for both sexes. We conclude that no support was found for the assumption that factors attributable to place of residence could explain the regional differences in sickness absence.

A comparison of perceived health, attitudes to work, leisure time, and social welfare systems among people in a rural area in the north of Sweden and among people in the city of Stockholm.

A problem attracting considerable attention in Sweden today is the substantial regional differences in sickness absence. The aim of the study was to investigate and compare how people, from a random sample of the population in both a rural area in the north of Sweden and the Swedish capital Stockholm, perceive their health, and what their attitudes are to work, leisure time and social welfare systems. Results showed that a larger proportion of those answering in Stockholm considered their health status to be "very good", compared with those in the rural area (p<0.0001). A majority in the rural area compared to the city of Stockholm reported a high or very high level of aches/pain (p<0.0001) and that work causes them physical problems p<0.0001). The population in both Stockholm and the rural area is of the opinion that the increase in sickness absence is mainly due to deterioration in the work environment. Almost half of the individuals in both the rural area and in Stockholm are of the opinion that many of those sick-listed are not actually ill. It may be that in the rural area in north Sweden people are more inclined to put their opinions to practice than those in Stockholm are.

Locus of control and regional differences in sickness absence in Sweden.

PURPOSE: The aim of this study was to investigate if there are differences in locus of control (LOC), at a societal level, between two residential areas in Sweden with substantial differences in sickness absence. METHOD: A postal questionnaire was sent to 1500 randomly selected men and women aged 20 - 64 years. Five hundred questionnaires were sent to people living in Stromsund (a sparsely populated municipality in northern Sweden with high rates of sickness absence) and 1000 questionnaires to people in the Swedish capital of Stockholm, which has a low rate of sickness absence. RESULTS AND CONCLUSION: A comparison of LOC in the two study areas supported our hypothesis to a certain extent, external locus being more prominent in Stromsund. When physical and mental health and income were considered, however, the differences disappeared. Consequently, this study did not support the opinion that differences in sickness absence can be explained by LOC at a societal level.

Nocturia in relation to somatic health, mental health and pain in adult men and women.

OBJECTIVE: To assess the relationship of nocturia to somatic health, mental health and bodily pain. SUBJECTS AND METHODS: A randomly selected group of men and women aged 20-64 years, living in three small municipalities in northern Sweden, or in the city of Ostersund or in Stockholm, were sent a postal questionnaire containing questions on somatic and mental health, satisfaction with life, pain, nocturnal voiding, work and sick-listing from work. RESULTS: Reports (from 1948 respondents) on poor somatic and mental health and on pain all increased in parallel with increasing frequency of nocturnal voids. In a multiple logistic regression analysis with sex, age, somatic health, mental health and bodily pain as the independent variables, significant independent correlates (odds ratios, confidence intervals) of nocturnal micturition (two or more episodes vs none or one) were: age 45-59 vs 20-44 years, 1.9 (1.3-2.7), > or =60 vs 20-44 years, 3.8 (2.4-6.0); somatic health, poor vs good, 2.3 (1.4-3.7); mental health, poor vs good, 1.9 (1.2-3.0); pain, rather mild vs very mild or none, 1.5 (1.0-2.3); rather severe vs very mild or none, 1.9 (1.1-3.2); and very severe vs very mild or none, 6.0 (2.5-14.0). Gender was deleted by the logistic model. Sick-listing for > or = 60 days during the past year was reported by 4.9%, 10.6%, 5.6% and 38.9% of the men with none, one, two or > or = three nocturnal voids, respectively, and by 10%, 12.4%, 23% and 46.7% (both P < 0.001) of the corresponding women, respectively. Life satisfaction decreased in parallel with increased nocturia. CONCLUSION: The impairment of both somatic and mental health was associated with increased nocturnal voiding. Pain was associated with a substantial increase in nocturia after adjusting for age and somatic and mental health. Sick-leave was more common in association with more nocturnal voids.