Perceived Stress, Multimorbidity, and Risk for Hospitalizations for Ambulatory Care–sensitive Conditions

A Population-based Cohort Study

Bibliographic Data

ID9099278
AuthorsAnders Prior (0000-0003-4053-3701, Aarhus University, corresponding author), Mogens Vestergaard (0009-0001-2937-4167, Aarhus University, corresponding author), Dimitry S Davydow (0009-0003-8605-9379, University of Washington), Karen Kjær Larsen (Aarhus University, corresponding author), Anette R Ribe (0000-0003-0011-2208, Aarhus University, corresponding author), Morten Fenger-Grøn (0000-0002-6354-5871, Aarhus University, corresponding author)
Year2017
Volume55
Issue2
Pages131-139
Publication date2017-02-01
Open AccessNo
TypeARTICLE
VenueMedical Care (JOURNAL)
Journal identifiersISSN: 0025-7079 • E-ISSN: 1537-1948
PublisherOvid Technologies (Wolters Kluwer Health) (PUBLISHER)
DOI10.1097/mlr.0000000000000632
PMID27579911
OpenAlexW2510472063
LanguageEN
Citations received2
References cited43

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

Ambulatory · Ambulatory care · Cohort · Cohort study · Comorbidity · Danish · Environmental health · Health care · Medical prescription · Perceived Stress Scale · Population · Socioeconomic status · Stress (linguistics) · Chronic Disease Management Strategies · Demography · Emergency Medicine · Internal Medicine · Medicine · Mental Health Treatment and Access · Primary Care and Health Outcomes · Pediatrics

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