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Am J Public Health. 1997 Mar;87(3):365-70.

Unmet health care needs and mortality among Spanish elderly.

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Health Services Research Unit, Institut Municipal d'Investigació Mèdica, Barcelona, Spain.



This study estimates the prevalence of unmet health care needs among the elderly of Barcelona, Spain, and analyzes the association between unmet needs and mortality.


Home interviews were conducted with 1315 elderly in Barcelona. Individuals were classified as having a "health services need" if they reported being in fair, poor, or very poor health; suffering from two or more chronic conditions; or being dependent in at least one basic activity of daily living. Need was considered unmet if no visits to or from a physician in the previous 12 months were reported. Mortality was assessed from census data in August 1991.


Between 10% and 25% of the elderly in need reported no use of health services. After a median of 60.3 months, those with unmet health care needs presented a higher risk of mortality, adjusted for several confounding factors: relative risk [RR] = 2.55 (95% confidence interval [CI] = 1.22, 5.32) for unmet activity of daily living dependency; RR = 1.80 (95% CI = 1.20, 2.70) for unmet comorbidity; and odds ratio = 1.10 (95% CI = 0.59, 2.05) for unmet poor self-rated health.


Noninstitutionalized elderly individuals with unmet health care needs are at increased risk of dying.

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