Social relationships and GP use of middle-aged and older adults in Europe: a moderator analysis

Abstract

ObjectivesThis paper investigates (1) how social relationships (SRs) relate to the frequency of general practitioner (GP) visits among middle-aged and older adults in Europe, (2) if SRs moderate the association between self-rated health and GP visits, and (3) how the associations vary regarding employment status.MethodsData stem from the Survey of Health, Ageing and Retirement in Europe project (wave 4, 56 989 respondents, 50 years or older). GP use was assessed by frequency of contacts with GPs in the last 12 months. Predictors were self-rated health and structural (Social Integration Index (SII), social contact frequency) and functional (emotional closeness) aspects of SR. Regressions were used to measure the associations between GP use and those predictors. Sociodemographic and socioeconomic factors were used as covariates. Additional models were computed with interactions.ResultsAnalyses did not reveal significant associations of functional and structural aspects of SR with frequency of GP visits (SII: incidence rate ratio (IRR)=0.99, 95% CI 0.97 to 1.01, social contact frequency: IRR=1.04, 95% CI 1.00 to 1.07, emotional closeness: IRR=1.02, 95% CI 1.00 to 1.04). Moderator analyses showed that ‘high social contact frequency people’ with better health had more statistically significant GP visits than ‘low social contact frequency people’ with better health. Furthermore, people with poor health and an emotionally close network showed a significantly higher number of GP visits compared with people with same health, but less close networks. Three-way interaction analyses indicated employment status specific behavioural patterns with regard to SR and GP use, but coefficients were mostly not significant. All in all, the not employed groups showed a higher number of GP visits.ConclusionsDifferent indicators of SR showed statistically insignificantly associations with GP visits. Consequently, the relevance of SR may be rated rather low in quantitative terms for investigating GP use behaviour of middle-aged and older adults in Europe. Nevertheless, investigating the two-way and three-way interactions indicated potential inequalities in GP use due to different characteristics of SR accounting for health and employment status.

A Bourdieusian approach to class‐related inequalities: the role of capitals and capital structure in the utilisation of healthcare services in later life

“…We chose this measure as studies have considered it to be in accordance with the health records of health providers, as well as a valid health status indicator for population health monitoring and a reliable predictor for GP and hospital use among older adults (Bremer et al . , Miilunpalo et al . , Ritter et al .…”

“…This was captured by self-perceived health status, rated on a five-point scale (excellent, very good, good, fair and poor). We chose this measure as studies have considered it to be in accordance with the health records of health providers, as well as a valid health status indicator for population health monitoring and a reliable predictor for GP and hospital use among older adults (Bremer et al 2018, Miilunpalo et al 1997, Ritter et al 2001, Vaillant and Wolff 2012Weinberger et al 1986). It also has an advantage in terms of capturing the biological, psychological and social dimensions of health, as opposed to only the medical diagnosis (Miilunpalo et al 1997).…”

“…This model points to the importance of three factors: those that are predisposing (individual characteristics such as age, gender, education and personal beliefs), enabling (structural and system‐level characteristics such as income and healthcare insurance) and needs related such as self‐perceived health or the degree of illness (Bremer et al . , Dey and Jorm , Lo et al . ).…”

“…Previous research on healthcare access draws on the dominant behavioural model of health service use (Andersen 1995). This model points to the importance of three factors: those that are predisposing (individual characteristics such as age, gender, education and personal beliefs), enabling (structural and system-level characteristics such as income and healthcare insurance) and needs related such as self-perceived health or the degree of illness (Bremer et al 2018, Dey and Jorm 2017, Lo et al 2016. Numerous studies have also looked at the access dimension of the use of healthcare services through the notions of availability, accessibility and affordability of healthcare services (Ensor 2004, Harris et al 2011, Kyriopoulos et al 2014, Yamada et al 2015.…”

ggeffects: Tidy Data Frames of Marginal Effects from Regression Models

“…ggeffects was already used in different publications for creating marginal effects plots (e.g. Bremer et al 2018). Figures were preferred over tables by authors and reviewers, since specifically interaction terms in logistic or negative binomial models are much easier to understand by visualization.…”