Hospitalizations and doctor visits among older adults in Europe: cross-country differences using a multilevel approach.

Abstract

Objective: To analyse the individual and country-level determinants of the use of healthcare systems by populations over 50 years of age in Europe.

Method: We conducted a cross-sectional study using data from Wave 7 (2017) of the Survey of Health, Ageing, and Retirement in Europe. The analysis included 27 countries. We fitted multilevel mixed-effects logistic regression models with hospitalization and doctor visits per person per year as dependent variables.

Results: The findings suggest that country-level variables explain between 3.3% and 4.9% of the differences in the likelihood of hospitalizations and approximately 10% of the likelihood of visiting a doctor at least once a year. Life expectancy and number of beds were the country-level variables most strongly associated with a reduced probability of hospitalization and doctor visits, respectively. The study also found that comorbidity and employment status were risk factors associated with hospitalization and doctor visits, while physical activity was a protective factor.

Conclusions: Country-level factors positively associated with higher health service use are the number of beds, health expenditure per capita and preventable mortality. Life expectancy and treatable mortality are negatively associated with the use of these services. Greater comorbidity increase the likelihood of hospitalization and medical visits, while higher muscular strength or regular physical activity reduce them.