Predictors of healthcare utilization among older Mexican Americans

Objective: To examine the effects of predisposing, enabling, and need factors on physician and hospital use among older Mexican Americans. Design: A two-year prospective cohort study. Setting: Five Southwestern states: Texas, New Mexico, Colorado, Arizona, and California. Participants: A population-based sample of 1987 non-institutionalized Mexican American men and women age ≥65 years. Main Outcomes Measures: Physician and hospital utilization. Predictor variables included predisposing, enabling, and need factors. Ordinary least square and logistic regression analysis were used to model the effects of predictor factors specified in the Andersen model of health service use on physician and hospital use. Results: After two years of follow-up, predisposing and enabling factors accounted for <5% of the variance in physician and hospital use. Need factors explained 21% of the variance in physician use and 7% of the variance in hospital use. Older age; being female; insurance coverage; having arthritis, diabetes, heart attack, hypertension, stroke, or cancer; and number of medications were factors associated with higher physician utilization. Subjects with arthritis, diabetes, hip fracture, high depressive symptoms, activities of daily living (ADL) disability, or high number of medications increased the odds of having any hospitalization. Subjects with diabetes, heart attack, hip fracture, ADL disabled, and high number of medications had a greater number of hospital nights than their counterparts. Conclusions: Older age, female sex, insurance coverage, and prevalent medical conditions are determinants of healthcare use among older Mexican Americans.