0230 Sleep Duration Associated with Hospital Utilization in the US: Revisiting Andersen's Behavioral Model of Health Service Use

Abstract

Introduction One in three Americans is sleep deprived, sleep disturbances are associated with greater health service utilization and costs. This study examined factors associated with Emergency Department visits (ED) and overnight admission hospitalization (OA) in a large representative sample of adults aged ≥18 in the US. Methods Guided by Andersen's Behavioral Model of Health Service Use, zero-inflated negative binomial and multivariable logistic regressions were used to examine associations between predisposing, enabling, and health needs factors and health service utilization (α=0.05). Results ED visits significantly increased with age, female sex, Black race, and less than high school education (15%, 36%, and 85%, respectively). Enabling factors analysis found that those who were unemployed, had problems paying medical bills, lived under the federal poverty line, and did not have private insurance were more likely to have ED visits. ED visits also increased by health needs including adults reporting poor/fair health, increased number of chronic conditions, and very short or long sleep. Regarding OA, significant risk predisposing factors included female sex and foreign-born nativity. Factors for OA found adults who were unemployed and had with problems paying bills were more likely to be hospitalized. Adults with Medicaid, Medicare, and other insurance were more likely (70%, 34%, 44%, respectively) to be hospitalized. Of the health needs factors examined, OA odds increased for those with less than excellent health status, without a usual source of care, and an increased number of chronic conditions. Adults with very short or short sleep were also more likely to be hospitalized (48% and 22%, respectively). Conclusion This is the first-time sleep duration is examined as a health needs component of Andersen's Behavioral Model of Health Service Use. When determining predictors associated with hospital utilization, sleep duration should be considered a key factor as it significantly increases the odds of ED visits and overnight hospital admissions. Future studies should investigate the influence of other dimensions of sleep health and sleep disorders. Support (if any) Programs to Increase Diversity among individuals engaged in Health-Related Research (PRIDE) training grant from the National Institutes of Health (NIH) National Heart, Lung, and Blood Institute (NHLBI): R25HL-10-5444 (PIs: G Jean-Louis, OG Ogedegbe).