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Med Care. 2017 Feb;55(2):131-139. doi: 10.1097/MLR.0000000000000632.

Perceived Stress, Multimorbidity, and Risk for Hospitalizations for Ambulatory Care-sensitive Conditions: A Population-based Cohort Study.

Author information

1
*The Research Unit and Section for General Practice, Department of Public Health, Aarhus University, Aarhus, Denmark †Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA.

Abstract

BACKGROUND:

Psychiatric disorders are associated with an increased risk for ambulatory care-sensitive condition (ACSC)-related hospitalizations, but it remains unknown whether this holds for individuals with nonsyndromic stress that is more prevalent in the general population.

OBJECTIVES:

To determine whether perceived stress is associated with ACSC-related hospitalizations and rehospitalizations, and posthospitalization 30-day mortality.

RESEARCH DESIGN AND MEASURES:

Population-based cohort study with 118,410 participants from the Danish National Health Survey 2010, which included data on Cohen's Perceived Stress Scale, followed from 2010 to 2014, combined with individual-level national register data on hospitalizations and mortality. Multimorbidity was assessed using health register information on diagnoses and drug prescriptions within 39 condition categories.

RESULTS:

Being in the highest perceived stress quintile was associated with a 2.13-times higher ACSC-related hospitalization risk (95% CI, 1.91, 2.38) versus being in the lowest stress quintile after adjusting for age, sex, follow-up time, and predisposing conditions. The associated risk attenuated to 1.48 (95% CI, 1.32, 1.67) after fully adjusting for multimorbidity and socioeconomic factors. Individuals with above reference stress levels experienced 1703 excess ACSC-related hospitalizations (18% of all). A dose-response relationship was observed between perceived stress and the ACSC-related hospitalization rate regardless of multimorbidity status. Being in the highest stress quintile was associated with a 1.26-times insignificantly increased adjusted risk (95% CI, 0.79, 2.00) for ACSC rehospitalizations and a 1.43-times increased adjusted risk (95% CI, 1.13, 1.81) of mortality within 30 days of admission.

CONCLUSIONS:

Elevated perceived stress levels are associated with increased risk for ACSC-related hospitalization and poor short-term prognosis.

PMID:
27579911
DOI:
10.1097/MLR.0000000000000632
[Indexed for MEDLINE]

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