Self-Rated Health and Health Care Utilization after Military Deployments

Abstract

Self-rated general health is one element of the standard health assessment required of U.S. military service members upon completion of major deployments. A cohort study of 22,229 male U.S. Army and Air Force personnel returning from Europe or Southwest Asia in 2000 used survival analysis methods and Cox proportional hazard models to examine postdeployment self-rated health (SRH) status and subsequent hospitalization, separation, and ambulatory care visits. Self-rated health was fair/poor for 1.5% and good for 20.4%; 11% documented at least one health concern. During 30,433 person-years of follow-up (median, 1.5 person-years), there were 22.8 hospitalizations per 1,000 person-years and 4.0 ambulatory care visits per person-years. After adjustment, deployers with fair/poor SRH had an increased risk for hospitalization (hazard ratio [HRI, 1.6; 95% confidence interval [CI], 1.0,2.7); the risk was lower for those with good SRH (HR, 1.3; 95% CI,1.1,1.5). Deployers with fair/poor SRH health had an increased risk for illness-related ambulatory care visits (HR, 1.8, 95%; CI, 1.6,2.1) and administrative visits (HR, 1.4; 95% CI, 1.1,1.7), but not injury-related visits (HR, 1.2; 95% CI, 0.8,1.7). Self-reported low health status and other health concerns identify military members with higher levels of health care needs following return from major deployments.

Losing confidence in medicine in an era of medical expansion?

“…Furthermore, these two seemingly contradictory phenomena result from the same social process of medical expansion. The process of medical expansion negatively affects individuals' subjective health (Zheng, 2011), and low subjective health predicts both increased utilization of health care (Andersen and Newman, 1973;DeSalvo et al, 2005;Trump, 2006;Bierman et al, 1999;Miilunpalo et al, 1997;Mutran and Ferraro, 1988) and lower confidence in the institution of medicine (Pescosolido et al, 2001;Tai-Seale and Pescosolido, 2003).…”

Health Status Inequality among Immigrants in Switzerland

“…First, even though selfrated health is strongly associated with mortality [57] and objective health status [58] [59], there is also evidence that the association between self-rated health and objective health status or mortality is weaker in less acculturated immigrants [60] [61]. Consequently, culture-specific connotations of health may bias our results despite the fact that we conducted a linguistic validation process that included a conceptual analysis of all original instruments in collaboration with the translators as well as forward and backward translations and a review of the backward translation.…”

Use of Complementary and Alternative Medicine and Self-Rated Health Status: Results from a National Survey

“…Poor self-rated health is associated with more functional limitations, greater use of resources [9][10][11][12][13][14][15][16] , and subsequent mortality, independent of objective health status 7,9 . Little is known about how the practice of CAM affects self-rated health and its change over time on a population level.…”