0895-4356/90$3.00+ 0.00
J ClinEpidemiol Vol. 43, No. 8, pp. 773-782, 1990
Copyright 0 1990Pergamon Press plc
Printed in Great Britain. All rights reserved
DISABILITY, PSYCHOSOCIAL FACTORS AND MORTALITY AMONG THE ELDERLY IN A RURAL FRENCH POPULATION A.
GRAND,’ P. GROSCLAUDE,’ H.
BOCQUET,’J. Pous’ and J. L. ALBAREDE~
‘Laboratoire d’Epid&miologie, Economic de la Santt et Prtvention, Facult6 de Mtdecine, 37 all&s Jules Guesde, F-31073 Toulouse Cedex and *Centre de Mtdecine Gkiatrique, 170 avenue de Casselardit, F-31300 Toulouse Cedex, France (Received in revised form 17 May 1989; received for publication 30 January 1990)
Abstract-The purpose of this work is to identify risk markers of mortality in a cohort of 645 people aged 60 and over. The study was carried out in rural areas in south west
France. Data were collected by questionnaire in 1982.Mortality was determined 4 years later; 111 deaths were registered. The analysis of age-adjusted odds ratios (OR) showed strong relationships between mortality and disability (OR = 7.75), compared health (OR = 3.94), self-rated health (OR = 2.47), home comfort (OR = 0.52), physical activity (OR = 0.32), sociability (OR = 0.43) and two subjective well-being items: the feeling of uselessness (OR = 3.51), and the lack of projects for the future (OR = 2.35). By contrast, no significant association was observed with reported morbidity and social support. Two multivariate analyses were performed: the first on longevity using Cox’s regression model, the second on mortality using a linear discriminant analysis. The results of these analyses were translated into a simple set of 8 independent risk markers for the identification of a “high risk group” of mortality within 4 years. The sensitivity of this mortality risk indicator was 73% and its specificity 77%. Disability
Psychosocial factors
Risk markers
INTRODUCTION
For several years, the study of the health status of elderly people has gone beyond the restrictive limits of morbidity to take an interest in the functional capacities and in the psychosocial environment [l]. The diversity and intricacy of elderly people’s diseases cannot be reliably measured by traditional epidemiological indicators. The geriatric practice shows that, more than the type and the number of diseases, it is the impact of this “set” of diseases on daily living and behaviour which must be taken into account in the management of elderly patients. Several indicators have been defined to measure this impact [2]: indicators of disability [3], self-
Mortality
Elderly
rated health [4], social support [5], subjective well-being [6] and life satisfaction [I. Even though these indicators explore the quality of life rather than the longevity, they are however suspected to be strongly related to the latter. Several research studies have focused on the analysis of such relationships, but they have usually concerned adults and not specifically elderly people [8,9]. House and Robbins [IO] noticed a lack of research concerning the elderly, but they are now receiving increasing attention. As a matter of fact, it is particularly interesting to study these relationships in elderly populations where a frail health status is associated with a frequent exposure to stressful life events (e.g. bereavement, retirement, moving,
773
714
hospitalization).
A.
GRAND et al.
However, two recent reviews
[ 1, 111show the persistence of a lack of research
into this issue in the epidemiology of ageing in France. At present, it is particularly important to multiply these studies in different cultural settings so as to assess the consistency of the results in different situations. Thus, one will be able to distinguish between the universal (transcultural) and conjunctural (monocultural) relationships. At present, several research studies have already demonstrated the link existing between some indicators and mortality in elderly people. Disability [12, 131 and self-rated health [14] appear to be very stable predictive factors of mortality. Such results made it possible to authenticate, from an epidemiological point of view, the link suspected from clinical geriatric practice. However, the variety of methodologies used in the research have often induced a diversity and even a divergence in the results regarding the relationships between the psychosocial factors and mortality [15]. This divergence concerns not only the type and the importance of identified effects but also the mechanism of action of these psychosocial factors on mortality. The effects obviously vary according to the method of measurement of the psychosocial variables, and according to the populations and sub-populations studied. It is therefore important to carry out studies on different kinds of populations but using standardized methodologies which allow comparisons. In fact, the instruments of measurement for the psychosocial factors are numerous, hardly transposable, and more often than not made up of scales (social support, morale, subjective health) enabling the calculation of scores which are confronted with mortality. If using such scores may reveal a relationship, it may on the contrary hide links existing between certain elementary dimensions of the scales and mortality. Therefore, it is important not only to study the global relationship but also to analyse the impact of each elementary item of the scale so as to better understand the processes which underlie the global relationship. Moreover, the low correlation often observed between psychosocial factors and mortality led the researchers to hypothesize that simple bivariate and causal models are inadequate and that all the different markers of mortality must be taken into consideration in the analysis [l 11. In fact, most studies often focus on one dimen-
sion (e.g. social ties, locus of control, coping behaviour) without taking the role played by the others into account. Indeed, all these dimensions are strongly related to each other. They are also strongly related to disability. Several studies have shown that the functional status is more related to the person’s psychology and to his way of life with his illness, than to the illness itself, such that it can be “objectively” assessed by professionals [16]. They are also strongly related to morbidity and sometimes the predictive role of a psychosocial factor may result from a disease which brings about both the low level of the psychosocial factor (e.g. depression, decreased social support) and short life-expectancy. According to Berkman [ 151, to eliminate such a problem the relationships identified must be adjusted to the initial level of morbidity. This explains the importance often emphasized by researchers to carry out a multifactorial approach in order to fully appreciate all the factors likely to influence longevity. The present study was designed so as to take these requirements into account, at least partially. Its main goal was to study the role of psychosocial factors on changes in the health status of a panel of 645 rural adults aged 60 and over, living at home and followed for 4 years (1982-1986). A previous analysis of the predictive factors of disability was performed on the same population [17]. We thus focused this work on the analysis of the 4-year mortality predictive factors. The results of these two analyses are very consistent as we will see in the Discussion. METHODS
Longitudinal Survey of an Elderly Rural Population The purpose of this survey was to study the conditions of ageing in rural areas, by the follow-up of a sample of 645 adults, aged 60 and over in 1982. This sample is representative of the elderly population of five rural areas in Haute-Garonne (south west France). The data of this study arise from an inquiry by questionnaire concerning the elderly themselves, and carried out in 1982. Variables of the Study The questionnaire, composed of closed questions, explored the main dimensions of gerontology, and in particular included 3 types of
Risk Markers
of Mortality
variable, which are presented in Table 1 along with their distributions. Health variables Reported morbidity. Different categories of disease were taken into account for the analysis, particularly those likely to have an impact on mortality, e.g. respiratory and cardiovascular diseases. A global indicator, measuring the number of reported diseases, was constructed. The accuracy of the report of their diseases by the elderly is questionable, but no direct assessment by professionals was possible. Disability. A global disability index ranging from 0 to 6 was calculated for each elderly person. It was derived from the indicator used by Colvez [18]. Self-rated health. The respondent was asked to situate his health level on a scale ranging from very bad to very good and to compare it to other elderly people’s health (compared health). Medical consumption. Although strongly related to the socioeconomic status, medical consumption (e.g. medical consulting frequency, hospitalization, number of medications taken) can also be considered as an indirect reflection of the state of health.
in a Rural
French
Population
115
Subjective well-being. This was measured by questions validated by Adams [19] for the analysis of life satisfaction. All deaths were registered during the followup period so that a survival duration could be calculated to make a survival analysis possible. Method of analysis
The processing of the data first included a correlation analysis between the different variables studied and mortality, under the control of age and with calculation of age-adjusted odds ratios (Table 1). This enabled us to measure the strength of the link between the risk marker and mortality. Then, a series of x2 was performed between the different variables to fully appreciate their relationships with each other (Table 2). This analysis showed the strong links existing between them. Therefore, in order to assess the independence of the impact of each risk marker on longevity, a multivariate survival analysis using Cox’s regression model [20,21] was carried out. It made it possible to highlight the predictive value of each variable on longevity and to identify the risk markers which have an independent impact on mortality. These independent risk markers were then included in a linear discriminant analysis. It enabled us to define a global risk indicator, composed of a simple set of 8 criteria Socioeconomic variables for the identification of a “high risk group” of Certain socioeconomic variables were tested, mortality. The sensitivity and the specificity of e.g. economic level, educational level and home .this indicator, as well as its positive predictive comfort. value, were calculated. Nevertheless, the variables identified as Psychosocial variables having an independent significant link with Activities. Among daily life and leisure activmortality cannot be considered as risk factors. ities, the analysis was focused on the impact of Indeed, despite the multivariate analysis, the physical activity. difficulty of demonstrating the mechanism of Social ties. A previous study on disability [ 171 action of these factors with our methodology incited us to group these variables into two prevent us from considering them as risk faccategories: tors. A further qualitative analysis would be -social support: this measures what the elderly necessary to analyse this mechanism of action person receives from his social network and and then allow us to consider them as risk corresponds to the passive dimension of his factors likely to be reduced by preventive relationships. It concerns cohabitation, proximactions. ity of the children, home help and the frequency of visits received. RESULTS -sociability: this measures the investment of the elderly in their social network and thus A total of 111 deaths were registered during corresponds to the active dimension of their the follow-up period: mortality was 17.2%. social relationships. It concerns visiting fre- Logically, it increased with age (Fig. 1). After quency, participation in club and association standardization, it was found to be signifiactivities. cantly higher for men (21.9%) than for women
A. GRANDet al.
776
Table 1. Aae-adiusted odds ratios: sex and health variables Variables Dependent 0 (alive) 1 (dead) Adjustment 1 (< 75) 2 (375)
Age-adjusted OR
Confidence intervals
Significance
0.66
0.42-0.98
p < 0.05
1.24
0.72-2.14
NS
0.87
0.38-1.99
NS
1.23
0.75-2.02
NS
0.66
0.42-l .03
NS
1.17
0.67-2.05
NS
1.38
0.85-2.24
NS
1.77
1.OO-2.98
NS
1.34
0.81-2.22
NS
1.37
0.76-2.48
NS
0.74
0.48-1.13
NS
1.32
0.82-2.10
NS
12.50
3.88-40.00
p < 0.001
8.40
3.88-18.18
p < 0.001
8.06
1.68-38.46
p i 0.001
7.63
3.22-18.18
p < 0.001
9.43
3.55-25.00
p < 0.001
3.76
2.42-5.85
p < 0.001
7.75
3.85-15.63
p < 0.001
2.47
1.464.17
p < 0.01
3.94
2.33-6.67
p < 0.001
2.01
1.30-3.09
p < 0.01
3.09
1.73-5.52
p < 0.001
variable: mortality 82.8% 17.2% variable: age 57.4% 42.6%
Sex 1 (male) 45% 2 (female) 55% Health varlablea Reported morbidity [0 (none reported);
1 (reported)] Metabolic diseases 0:82.7% 1: 17.3% Mental diseases (except mental deterioration) 0:92.1% 1:7.9% Sensory disabilities 0:82.1% 1:17.9% Hypertension 0: 62.8% 1~37.2% Cardioischemic diseases 0: 86.1% 1:13.9% Vascular diseases 0:77.9% 1:22.1% Respiratory diseases 0:84.4% 1:15.6% Gastroenterological diseases 0:80.1% 1:19.9% Genitourinary diseases 0:86.9% 1:13.1% Osteoarticular diseases 0:43.9% 1:56.1% Number of reported diseases 1 (3):22.7%
Disability [0 (no); 1 (yes)]
Confined to bed or chair 0:96.9% 1:3.1% Confined to home 0:94.6% 1:5.4% Needs help for eating 0:98% 1:2% Needs help for dressing 0:95.2% 1:4.8% Needs help for going to the toilet 0:96.9% 1:3.1% Needs help for walking 1 km at a time 0:71.1% 1:28.9% Disability index (sum of the 6 disability items): 1 (index c 5):93% 2 (index 2 5):7% Self-rated health
Rated health 1 (average or good):84.6% 2 (bad, very bad):15.4% Compared health 1 (same or better):85.3% 2 (worse): 14.7% Medical consumption
Medical consulting frequency (in the past year) 1 (c 10):59.8% 2 (> 10):40.2% Hospitalization (in the past year) 0 (no):90% 1 (yes): 10%
-continued
111
Risk Markers of Mortality in a Rural French Population Table l-continued Variables Number of medications taken (in the past week) 0 (2):53.8% Socioeconomic
Confidence intervals
Significance
2.00
1.263.17
p < 0.01
0.74
0.45-I .22
NS
0.59
0.37-0.95
p < 0.05
0.52
0.314.87
p < 0.05
0.32
0.20-0.49
p < 0.001
1.15
0.67-1.94
NS
0.97
O.&l.58
NS
0.69
0.45-l .06
NS
0.76
0.461.24
NS
0.43
0.24-0.74
p < 0.01
0.62
0.361.09
NS
1.42 2.53 1.96 1.13 3.51
0.81-2.50 0.99-5.62 0.884.39 0.60-2.11 2.024.10
NS NS
2.04
l.OS4.08
NS
1.16
0.7&1.91
NS
2.35
1.41-3.91
p < 0.01
variables
Income level (pays income taxes) 1 (no) 64.9% 2 (yes) 35.1% Educational level 1 (
J ClinEpidemiol Vol. 43, No. 8, pp. 773-782, 1990
Copyright 0 1990Pergamon Press plc
Printed in Great Britain. All rights reserved
DISABILITY, PSYCHOSOCIAL FACTORS AND MORTALITY AMONG THE ELDERLY IN A RURAL FRENCH POPULATION A.
GRAND,’ P. GROSCLAUDE,’ H.
BOCQUET,’J. Pous’ and J. L. ALBAREDE~
‘Laboratoire d’Epid&miologie, Economic de la Santt et Prtvention, Facult6 de Mtdecine, 37 all&s Jules Guesde, F-31073 Toulouse Cedex and *Centre de Mtdecine Gkiatrique, 170 avenue de Casselardit, F-31300 Toulouse Cedex, France (Received in revised form 17 May 1989; received for publication 30 January 1990)
Abstract-The purpose of this work is to identify risk markers of mortality in a cohort of 645 people aged 60 and over. The study was carried out in rural areas in south west
France. Data were collected by questionnaire in 1982.Mortality was determined 4 years later; 111 deaths were registered. The analysis of age-adjusted odds ratios (OR) showed strong relationships between mortality and disability (OR = 7.75), compared health (OR = 3.94), self-rated health (OR = 2.47), home comfort (OR = 0.52), physical activity (OR = 0.32), sociability (OR = 0.43) and two subjective well-being items: the feeling of uselessness (OR = 3.51), and the lack of projects for the future (OR = 2.35). By contrast, no significant association was observed with reported morbidity and social support. Two multivariate analyses were performed: the first on longevity using Cox’s regression model, the second on mortality using a linear discriminant analysis. The results of these analyses were translated into a simple set of 8 independent risk markers for the identification of a “high risk group” of mortality within 4 years. The sensitivity of this mortality risk indicator was 73% and its specificity 77%. Disability
Psychosocial factors
Risk markers
INTRODUCTION
For several years, the study of the health status of elderly people has gone beyond the restrictive limits of morbidity to take an interest in the functional capacities and in the psychosocial environment [l]. The diversity and intricacy of elderly people’s diseases cannot be reliably measured by traditional epidemiological indicators. The geriatric practice shows that, more than the type and the number of diseases, it is the impact of this “set” of diseases on daily living and behaviour which must be taken into account in the management of elderly patients. Several indicators have been defined to measure this impact [2]: indicators of disability [3], self-
Mortality
Elderly
rated health [4], social support [5], subjective well-being [6] and life satisfaction [I. Even though these indicators explore the quality of life rather than the longevity, they are however suspected to be strongly related to the latter. Several research studies have focused on the analysis of such relationships, but they have usually concerned adults and not specifically elderly people [8,9]. House and Robbins [IO] noticed a lack of research concerning the elderly, but they are now receiving increasing attention. As a matter of fact, it is particularly interesting to study these relationships in elderly populations where a frail health status is associated with a frequent exposure to stressful life events (e.g. bereavement, retirement, moving,
773
714
hospitalization).
A.
GRAND et al.
However, two recent reviews
[ 1, 111show the persistence of a lack of research
into this issue in the epidemiology of ageing in France. At present, it is particularly important to multiply these studies in different cultural settings so as to assess the consistency of the results in different situations. Thus, one will be able to distinguish between the universal (transcultural) and conjunctural (monocultural) relationships. At present, several research studies have already demonstrated the link existing between some indicators and mortality in elderly people. Disability [12, 131 and self-rated health [14] appear to be very stable predictive factors of mortality. Such results made it possible to authenticate, from an epidemiological point of view, the link suspected from clinical geriatric practice. However, the variety of methodologies used in the research have often induced a diversity and even a divergence in the results regarding the relationships between the psychosocial factors and mortality [15]. This divergence concerns not only the type and the importance of identified effects but also the mechanism of action of these psychosocial factors on mortality. The effects obviously vary according to the method of measurement of the psychosocial variables, and according to the populations and sub-populations studied. It is therefore important to carry out studies on different kinds of populations but using standardized methodologies which allow comparisons. In fact, the instruments of measurement for the psychosocial factors are numerous, hardly transposable, and more often than not made up of scales (social support, morale, subjective health) enabling the calculation of scores which are confronted with mortality. If using such scores may reveal a relationship, it may on the contrary hide links existing between certain elementary dimensions of the scales and mortality. Therefore, it is important not only to study the global relationship but also to analyse the impact of each elementary item of the scale so as to better understand the processes which underlie the global relationship. Moreover, the low correlation often observed between psychosocial factors and mortality led the researchers to hypothesize that simple bivariate and causal models are inadequate and that all the different markers of mortality must be taken into consideration in the analysis [l 11. In fact, most studies often focus on one dimen-
sion (e.g. social ties, locus of control, coping behaviour) without taking the role played by the others into account. Indeed, all these dimensions are strongly related to each other. They are also strongly related to disability. Several studies have shown that the functional status is more related to the person’s psychology and to his way of life with his illness, than to the illness itself, such that it can be “objectively” assessed by professionals [16]. They are also strongly related to morbidity and sometimes the predictive role of a psychosocial factor may result from a disease which brings about both the low level of the psychosocial factor (e.g. depression, decreased social support) and short life-expectancy. According to Berkman [ 151, to eliminate such a problem the relationships identified must be adjusted to the initial level of morbidity. This explains the importance often emphasized by researchers to carry out a multifactorial approach in order to fully appreciate all the factors likely to influence longevity. The present study was designed so as to take these requirements into account, at least partially. Its main goal was to study the role of psychosocial factors on changes in the health status of a panel of 645 rural adults aged 60 and over, living at home and followed for 4 years (1982-1986). A previous analysis of the predictive factors of disability was performed on the same population [17]. We thus focused this work on the analysis of the 4-year mortality predictive factors. The results of these two analyses are very consistent as we will see in the Discussion. METHODS
Longitudinal Survey of an Elderly Rural Population The purpose of this survey was to study the conditions of ageing in rural areas, by the follow-up of a sample of 645 adults, aged 60 and over in 1982. This sample is representative of the elderly population of five rural areas in Haute-Garonne (south west France). The data of this study arise from an inquiry by questionnaire concerning the elderly themselves, and carried out in 1982. Variables of the Study The questionnaire, composed of closed questions, explored the main dimensions of gerontology, and in particular included 3 types of
Risk Markers
of Mortality
variable, which are presented in Table 1 along with their distributions. Health variables Reported morbidity. Different categories of disease were taken into account for the analysis, particularly those likely to have an impact on mortality, e.g. respiratory and cardiovascular diseases. A global indicator, measuring the number of reported diseases, was constructed. The accuracy of the report of their diseases by the elderly is questionable, but no direct assessment by professionals was possible. Disability. A global disability index ranging from 0 to 6 was calculated for each elderly person. It was derived from the indicator used by Colvez [18]. Self-rated health. The respondent was asked to situate his health level on a scale ranging from very bad to very good and to compare it to other elderly people’s health (compared health). Medical consumption. Although strongly related to the socioeconomic status, medical consumption (e.g. medical consulting frequency, hospitalization, number of medications taken) can also be considered as an indirect reflection of the state of health.
in a Rural
French
Population
115
Subjective well-being. This was measured by questions validated by Adams [19] for the analysis of life satisfaction. All deaths were registered during the followup period so that a survival duration could be calculated to make a survival analysis possible. Method of analysis
The processing of the data first included a correlation analysis between the different variables studied and mortality, under the control of age and with calculation of age-adjusted odds ratios (Table 1). This enabled us to measure the strength of the link between the risk marker and mortality. Then, a series of x2 was performed between the different variables to fully appreciate their relationships with each other (Table 2). This analysis showed the strong links existing between them. Therefore, in order to assess the independence of the impact of each risk marker on longevity, a multivariate survival analysis using Cox’s regression model [20,21] was carried out. It made it possible to highlight the predictive value of each variable on longevity and to identify the risk markers which have an independent impact on mortality. These independent risk markers were then included in a linear discriminant analysis. It enabled us to define a global risk indicator, composed of a simple set of 8 criteria Socioeconomic variables for the identification of a “high risk group” of Certain socioeconomic variables were tested, mortality. The sensitivity and the specificity of e.g. economic level, educational level and home .this indicator, as well as its positive predictive comfort. value, were calculated. Nevertheless, the variables identified as Psychosocial variables having an independent significant link with Activities. Among daily life and leisure activmortality cannot be considered as risk factors. ities, the analysis was focused on the impact of Indeed, despite the multivariate analysis, the physical activity. difficulty of demonstrating the mechanism of Social ties. A previous study on disability [ 171 action of these factors with our methodology incited us to group these variables into two prevent us from considering them as risk faccategories: tors. A further qualitative analysis would be -social support: this measures what the elderly necessary to analyse this mechanism of action person receives from his social network and and then allow us to consider them as risk corresponds to the passive dimension of his factors likely to be reduced by preventive relationships. It concerns cohabitation, proximactions. ity of the children, home help and the frequency of visits received. RESULTS -sociability: this measures the investment of the elderly in their social network and thus A total of 111 deaths were registered during corresponds to the active dimension of their the follow-up period: mortality was 17.2%. social relationships. It concerns visiting fre- Logically, it increased with age (Fig. 1). After quency, participation in club and association standardization, it was found to be signifiactivities. cantly higher for men (21.9%) than for women
A. GRANDet al.
776
Table 1. Aae-adiusted odds ratios: sex and health variables Variables Dependent 0 (alive) 1 (dead) Adjustment 1 (< 75) 2 (375)
Age-adjusted OR
Confidence intervals
Significance
0.66
0.42-0.98
p < 0.05
1.24
0.72-2.14
NS
0.87
0.38-1.99
NS
1.23
0.75-2.02
NS
0.66
0.42-l .03
NS
1.17
0.67-2.05
NS
1.38
0.85-2.24
NS
1.77
1.OO-2.98
NS
1.34
0.81-2.22
NS
1.37
0.76-2.48
NS
0.74
0.48-1.13
NS
1.32
0.82-2.10
NS
12.50
3.88-40.00
p < 0.001
8.40
3.88-18.18
p < 0.001
8.06
1.68-38.46
p i 0.001
7.63
3.22-18.18
p < 0.001
9.43
3.55-25.00
p < 0.001
3.76
2.42-5.85
p < 0.001
7.75
3.85-15.63
p < 0.001
2.47
1.464.17
p < 0.01
3.94
2.33-6.67
p < 0.001
2.01
1.30-3.09
p < 0.01
3.09
1.73-5.52
p < 0.001
variable: mortality 82.8% 17.2% variable: age 57.4% 42.6%
Sex 1 (male) 45% 2 (female) 55% Health varlablea Reported morbidity [0 (none reported);
1 (reported)] Metabolic diseases 0:82.7% 1: 17.3% Mental diseases (except mental deterioration) 0:92.1% 1:7.9% Sensory disabilities 0:82.1% 1:17.9% Hypertension 0: 62.8% 1~37.2% Cardioischemic diseases 0: 86.1% 1:13.9% Vascular diseases 0:77.9% 1:22.1% Respiratory diseases 0:84.4% 1:15.6% Gastroenterological diseases 0:80.1% 1:19.9% Genitourinary diseases 0:86.9% 1:13.1% Osteoarticular diseases 0:43.9% 1:56.1% Number of reported diseases 1 (3):22.7%
Disability [0 (no); 1 (yes)]
Confined to bed or chair 0:96.9% 1:3.1% Confined to home 0:94.6% 1:5.4% Needs help for eating 0:98% 1:2% Needs help for dressing 0:95.2% 1:4.8% Needs help for going to the toilet 0:96.9% 1:3.1% Needs help for walking 1 km at a time 0:71.1% 1:28.9% Disability index (sum of the 6 disability items): 1 (index c 5):93% 2 (index 2 5):7% Self-rated health
Rated health 1 (average or good):84.6% 2 (bad, very bad):15.4% Compared health 1 (same or better):85.3% 2 (worse): 14.7% Medical consumption
Medical consulting frequency (in the past year) 1 (c 10):59.8% 2 (> 10):40.2% Hospitalization (in the past year) 0 (no):90% 1 (yes): 10%
-continued
111
Risk Markers of Mortality in a Rural French Population Table l-continued Variables Number of medications taken (in the past week) 0 (2):53.8% Socioeconomic
Confidence intervals
Significance
2.00
1.263.17
p < 0.01
0.74
0.45-I .22
NS
0.59
0.37-0.95
p < 0.05
0.52
0.314.87
p < 0.05
0.32
0.20-0.49
p < 0.001
1.15
0.67-1.94
NS
0.97
O.&l.58
NS
0.69
0.45-l .06
NS
0.76
0.461.24
NS
0.43
0.24-0.74
p < 0.01
0.62
0.361.09
NS
1.42 2.53 1.96 1.13 3.51
0.81-2.50 0.99-5.62 0.884.39 0.60-2.11 2.024.10
NS NS
2.04
l.OS4.08
NS
1.16
0.7&1.91
NS
2.35
1.41-3.91
p < 0.01
variables
Income level (pays income taxes) 1 (no) 64.9% 2 (yes) 35.1% Educational level 1 (
