Social and clinical determinants of the use of health services in women with breast cancer (Cohort DAMA)
Por:
Puigpinos-Riera, R, Gomez, AC, Morales, AR, Aller, M, Castells, X, Sala, M, Bargallo, X, Domenech, M, Espinosa-Bravo, M, Grau, J, Macia, F, Manzanera, R, Pla, M, Quintana, MJ, Vidal, E
Publicada:
1 sep 2019
Resumen:
Objective: To describe and analyse the factors associated with the use of health services (emergency departments, admissions and primary care) in women survivors of breast cancer diagnosed or treated in four university hospitals of Barcelona (Spain) between 2003 and 2013, within the framework of the Cohort DAMA project.
Method: Descriptive design nested in a mixed cohort (Cohort Dama). We obtained sociodemographic information and information on the use of health services through a questionnaire, and on the tumour from the clinical history. Logistic regression models were performed, calculating the odds ratio of the use of health services (emergency departments, hospital admissions and primary care) raw and adjusted (aOR) by diagnostic method, the characteristics of the tumour and of the women and their 95% confidence intervals.
Results: The presence of chronic diseases was associated with greater use of the three levels of care. A disadvantaged economic level increases the risk of use of emergency departments and primary care but not of hospital admissions, while a higher tumour stage is associated with a greater risk of admission. By age, those under 50 had a higher risk of using emergency departments and admissions.
Conclusions: The factors associated with the use of health services differ according to the level of care (aOR: 3.53 emergency departments, 1.67 admissions, 3.89 primary care) and treatment-derived complications (aOR: 1.35 emergency departments, 1.43 primary care). The presence of chronic disorders, younger age, disadvantaged social class, increases the risk of using services more than the tumour stage and treatment-derived complications. Neither the diagnostic method nor the survival time, nor the use of non-conventional therapies influence this. (C) 2018 SESPAS. Published by Elsevier Espana, S.L.U. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
Filiaciones:
Puigpinos-Riera, R:
Agcy Salut Publ Barcelona, Barcelona, Spain
CIBERESP, Madrid, Spain
Inst Recerca Biomed St Pau, Barcelona, Spain
Inst Recerca St Pau, CIBER Epidemiol & Salud Publ, Agencia Salut Publ Barcelona, Barcelona, Spain
Gomez, AC:
Inst Hosp Mar Invest Med, Serv Epidemiol & Avaluacio, Barcelona, Spain
Morales, AR:
Inst Hosp Mar Invest Med, Serv Epidemiol & Avaluacio, Barcelona, Spain
Red Invest Serv Salud REDISSEC, Tenerife, Spain
Aller, M:
Inst Hosp Mar Invest Med, Serv Epidemiol & Avaluacio, Barcelona, Spain
Red Invest Serv Salud REDISSEC, Tenerife, Spain
Castells, X:
Inst Hosp Mar Invest Med, Serv Epidemiol & Avaluacio, Barcelona, Spain
Red Invest Serv Salud REDISSEC, Tenerife, Spain
Univ Autonoma Barcelona, Fac Med, Dept Pediat Ginecol & Obstet & Med Prevent & Salu, Barcelona, Spain
Sala, M:
Inst Hosp Mar Invest Med, Serv Epidemiol & Avaluacio, Barcelona, Spain
Red Invest Serv Salud REDISSEC, Tenerife, Spain
Univ Autonoma Barcelona, Fac Med, Dept Pediat Ginecol & Obstet & Med Prevent & Salu, Barcelona, Spain
Univ Autonoma Barcelona, Inst Hosp Mar Invest Med, Red Invest Serv Salud, Barcelona, Spain
Bargallo, X:
Hosp Clin Barcelona, Barcelona, Spain
Domenech, M:
Assoc Mujeres Canc Mama Agatal, Barcelona, Spain
Espinosa-Bravo, M:
Hosp Univ Vall Hebron, Barcelona, Spain
Grau, J:
Hosp Clin Barcelona, Barcelona, Spain
Macia, F:
Inst Municipal Invest Med, Parc Salut Mar Barcelona, Barcelona, Spain
Manzanera, R:
MC Mutual Med, Badalona, Spain
Pla, M:
Univ Barcelona, Barcelona, Spain
Quintana, MJ:
Hosp Sta Creu & St Pau, Inst Recerca Biomed St Pau, CIBER Epidemiol & Salud Publ, Barcelona, Spain
Vidal, E:
Univ Ramon Llull, Fac Ciencies Salut Blanquerna, Barcelona, Spain
Gold, Green Accepted
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