AN ANALYSIS OF THE LINK BETWEEN BEHAVIORAL, BIOLOGICAL & SOCIAL RISK FACTORS
AN ANALYSIS OF THE LINK BETWEEN BEHAVIORAL, BIOLOGICAL & SOCIAL RISK FACTORS and Subsequent Hospital Admission in Scotland
ABSTRACT
Objective To determine the association between risk factors and hospital admission.
Methods The 1998 Scottish Health Survey was linked to the Scottish hospital admission database.
Findings Smoking was the most important behavioral risk factor (hazard ratio: 1.90, 95% CI: 1.59–2.27). Other behavioral risk factors yielded small but largely anticipated results. Hazard ratios for biological risks increased predictably but with some exceptions (blood pressure and total cholesterol). The top quintile for C-reactive protein showed almost double the risk of admission compared with the bottom quintile (hazard ratio: 1.93, 95% CI: 1.52–2.46). Elevated body mass index (BMI) increased the risk of serious admission (hazard ratio: 1.23, 95% CI: 1.03–1.47) and raised gamma-GT increased this risk by 20% (hazard ratio: 1.20, 95% CI: 1.04–1.38). Forced expiratory volume was the ‘biological’ factor with the largest risk (hazard ratio for lowest category: 1.82, 95% CI: 1.49–2.22). All the measures of social position showed variable effects on the risk of hospital admission. Large effects on risk were associated with self-assessed health, longstanding illness and previous admission.
Conclusion The linkage of national surveys with a prospective hospitalization database will develop into an increasingly powerful tool.
Keywords hospital admission, linked datasets, risk factors, Scottish Health Survey
Introduction
Epidemiology is the ‘study of the distribution and determinants of health-related states and events in populations’.1 However, within epidemiology, more is known about the aetiology of disease than is understood about some of the determinants of health service utilization. 2 Yet, both are important.
We know that the factors that determine demand for health services are complex and interacting. They include the levels of disease in a population, the volume and nature of health service supply, the behavior of key ‘gate keepers’, the expectations and help-seeking behaviors of the population, demographic factors, social capital and much else.
Although these general insights are valuable, relatively little work has been done, using large national samples, on the interaction between established disease risk factors like obesity,
raised blood pressure, elevated cholesterol and smoking on the pattern of hospital utilization. Still less is understood about newer risk factors like C-reactive protein and fibrinogen.7,8.
Also, although the relationship between deprivation and high levels of health service demand is well established,9 the degree to which deprivation acts through known biological and behavioral risk factors is less well understood.
The purpose of this study is to address these areas of relative ignorance by taking advantage of a new resource created by the linkage of lifestyle and hospital utilization data across Scotland.
It is only in the past 3 years that it has been possible, using probability matching techniques,10 to link Scottish Morbidity Records (SMRs) with the Scottish Health Survey (SHS). SHS respondents are asked at the end of their interview whether they would be willing to be re-contacted and to allow their records to be checked against NHS registers… The survey achieves a response rate of over80% and 90% of respondents consent to record linkage.
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Regards, Coyalita
Behavioral Health Rehabilitative Specialist & Addiction Counselor
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