Abstract
Ghana’s older adult population is growing significantly. However, there is limited knowledge or research on the effect of place, chronic health conditions, and socioeconomic status on the risk of overnight hospital admission or the frequency of hospitalisation among older adults in Ghana. Using the WHO SAGE (Wave 1) data, we examine the influence of place of residence, chronic health conditions, and socioeconomic status on overnight hospital admission, as well as, frequency of hospital admission among older adults in Ghana. Multivariate logistic regression and zero-inflated negative binomial regression models were used to study the influence of place, health conditions, and socioeconomic status on overnight hospital admission. The findings show that older adults with functional limitations and chronical health conditions were more likely to have experienced an overnight hospital admission. The expected number of overnight hospital admission was greater among chronically ill older adults than their healthy counterparts. However, the findings show that socioeconomically vulnerable older adults were less likely to have overnight hospital admission and they had lower admission rates. The presence of chronic health conditions is associated with overnight hospital admission, while poor socioeconomic status may imply underutilization or limited access to healthcare for the socioeconomically vulnerable.
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Aboderin, I. (2004). Decline in material family support for older people in urban Ghana, Africa: Understanding processes and causes of change. Journals of Gerontology – Series B Psychological Sciences and Social Sciences, 59(3), S128–S137. https://doi.org/10.1093/geronb/59.3.S128.
Abubakari, A. R., Lauder, W., Agyemang, C., Jones, M., Kirk, A., & Bhopal, R. S. (2008). Prevalence and time trends in obesity among adult west African populations: A meta-analysis. Obesity Reviews, 9(4), 297–311. https://doi.org/10.1111/j.1467-789X.2007.00462.x.
Agyei-Mensah, S., & de Aikins, G. A. (2010). Epidemiological transition and the double burden of disease in Accra, Ghana. Journal of Urban Health : Bulletin of the New York Academy of Medicine, 87(5), 879–897. https://doi.org/10.1007/s11524-010-9492-y.
Agyemang, C., Bruijnzeels, M. A., & Owusu-Dabo, E. (2006). Factors associated with hypertension awareness, treatment, and control in Ghana, West Africa. Journal of Human Hypertension, 20(1), 67–71. https://doi.org/10.1038/sj.jhh.1001923.
Agyemang, C. (2006). Rural and urban differences in blood pressure and hypertension in Ghana, West Africa. Public Health, 120(6), 525–533. https://doi.org/10.1016/j.puhe.2006.02.002.
de Aikins, G. A. (2007). Ghana’s neglected chronic disease epidemic: A developmental challenge. Ghana Medical Journal, 41(4), 154–159.
de Aikins, G. A., Kushitor, M., Koram, K., Gyamfi, S., & Ogedegbe, G. (2014). Chronic non-communicable diseases and the challenge of universal health coverage: insights from community-based cardiovascular disease research in urban poor communities in Accra, Ghana. BMC Public Health, 14(Suppl 2(Suppl 2)), S3. https://doi.org/10.1186/1471-2458-14-S2-S3.
Akazili, J., Garshong, B., Aikins, M., Gyapong, J., & McIntyre, D. (2012). Progressivity of health care financing and incidence of service benefits in Ghana. Health Policy and Planning, 27(Suppl. 1), i13–i22. https://doi.org/10.1093/heapol/czs004.
Alley, D. E., & Chang, V. W. (2007). The changing relationship of obesity and disability, 1988–2004. Journal of the American Medical Association, 298(17), 2020–2027. https://doi.org/10.1001/jama.298.17.2020.
Alley, D. E., Ferrucci, L., Barbagallo, M., Studenski, S. A., & Harris, T. B. (2008). A research agenda: The changing relationship between body weight and health in aging. Journals of Gerontology – Series A Biological Sciences and Medical Sciences, 63(11), 1257–1259. https://doi.org/10.1093/gerona/63.11.1257.
Amegbor, P. M. (2017a). An assessment of care-seeking behavior in Asikuma-Odoben-Brakwa District: A triple pluralistic health sector approach. SAGE Open, 7(2), 1–17. https://doi.org/10.1177/2158244017710688.
Amegbor, P. M. (2017b). Understanding usage and preference for health care therapies in a Ghanaian context: A pluralistic perspective. Norsk Geografisk Tidsskrift – Norwegian Journal of Geography, 71(5), 288–300. https://doi.org/10.1080/00291951.2017.1340908.
Amegbor, P. M., Kuuire, V. Z., Robertson, H., & Kuffuor, O. A. (2018). Predictors of basic self-care and intermediate self-care functional disabilities among older adults in Ghana. Archives of Gerontology and Geriatrics, 77(December 2017), 81–88. https://doi.org/10.1016/j.archger.2018.04.006.
Amoah, A. G. (2003). Sociodemographic variations in obesity among Ghanaian adults. Public Health Nutrition, 6(8), 751–757. https://doi.org/10.1079/phn2003506.
Appiah, L. T., Sarfo, F. S., Agyemang, C., Tweneboah, H. O., Appiah, N. A. B. A., Bedu-Addo, G., & Opare-Sem, O. (2017). Current trends in admissions and outcomes of cardiac diseases in Ghana. Clinical Cardiology, 40(10), 783–788. https://doi.org/10.1002/clc.22753.
Apt, N. A. (2002). Ageing and the changing role of the family and the community: An African perspective. International Social Security Review, 55(1), 39–47. https://doi.org/10.1111/1468-246X.00113.
Arthur, E. (2012). Wealth and antenatal care use: Implications for maternal health care utilisation in Ghana. Health Economics Review, 2(1), 1–8. https://doi.org/10.1186/2191-1991-2-14.
Aryeetey, G. C., Jehu-Appiah, C., Kotoh, A. M., Spaan, E., Arhinful, D. K., Baltussen, R., van der Geest, S., & Agyepong, I. A. (2013). Community concepts of poverty: An application to premium exemptions in Ghana’s National Health Insurance Scheme. Globalization and Health, 9(1), 12. https://doi.org/10.1186/1744-8603-9-12.
BeLue, R., Okoror, T. A., Iwelunmor, J., Taylor, K. D., Degboe, A. N., Agyemang, C., & Ogedegbe, G. (2009). An overview of cardiovascular risk factor burden in sub-Saharan African countries: A socio-cultural perspective. Globalization and Health, 5, 1–12. https://doi.org/10.1186/1744-8603-5-10.
Bertakis, K. D., Azari, R., Callahan, E. J., & Robbins, J. A. (2000). Gender differences in the utilization of health care services. The Journal of Family Practice, 49, 147.
Blanchet, N. J., Fink, G., & Osei-Akoto, I. (2012). The effect of Ghana’s National Health Insurance Scheme on health care utilisation. Ghana Medical Journal, 46(2), 76–84.
Boakye, J., Mensah, D., Sakhuja, S., Jolly, P. E., & Akinyemiju, T. (2017). Socioeconomic disparities in the prevalence of Cardiometabolic risk factors in Ghanaian women. Annal of Global Health, 83(3–4), 423–431. https://doi.org/10.1016/j.aogh.2017.05.004.
Böckerman, P., & Maczulskij, T. (2016). The education-health Nexus: Fact and fiction. Social Science and Medicine, 150, 112–116. https://doi.org/10.1016/j.socscimed.2015.12.036.
Bonate, P. L. (2011). Pharmacokinetic-pharmacodynamic modeling and simulation(second). New York: Springer US. https://doi.org/10.1007/978-1-4419-9485-1.
Buor, D. (2002). Distance as a predominant factor in the utilisation of health services in the Kumasi metropolis, Ghana. GeoJournal, 56(2), 145–157. https://doi.org/10.1023/A:1022452311911.
Chatterji, S., & Kowal, P. (2010). WHO study on global ageing and adult health ( SAGE): Wave 1, 2007–2010. Ann Arbor: Inter-university Consortium for Political and Social Research. https://doi.org/10.3886/ICPSR31381.v1.
Dalal, S., Beunza, J. J., Volmink, J., Adebamowo, C., Bajunirwe, F., Njelekela, M., Mozaffarian, D., Fawzi, W., Willett, W., Adami, H. O., & Holmes, M. D. (2011). Non-communicable diseases in sub-Saharan Africa: What we know now. International Journal of Epidemiology, 40(4), 885–901. https://doi.org/10.1093/ije/dyr050.
Damasceno, A., Azevedo, A., Silva-Matos, C., Prista, A., Diogo, D., & Lunet, N. (2009). Hypertension prevalence, awareness, treatment, and control in Mozambique: Urban/rural gap during epidemiological transition. Hypertension, 54(1), 77–83. https://doi.org/10.1161/HYPERTENSIONAHA.109.132423.
Danquah, I., Bedu-Addo, G., Terpe, K.-J., Micah, F., Amoako, Y. A., Awuku, Y. A., Dietz, E., van der Giet, M., Spranger, J., & Mockenhaupt, F. P. (2012). Diabetes mellitus type 2 in urban Ghana: Characteristics and associated factors. BMC Public Health, 12(1), 210. https://doi.org/10.1186/1471-2458-12-210.
Davies, A., Cifaldi, M. A., Segurado, O. G., & Weisman, M. H. (2009). Cost-effectiveness of sequential therapy with tumor necrosis factor antagonists in early rheumatoid arthritis. Journal of Rheumatology, 36(1), 16–25. https://doi.org/10.3899/jrheum.080257.
Depalma, G., Xu, H., Covinsky, K. E., Craig, B. A., Stallard, E., Thomas, J., & Sands, L. P. (2013). Hospital readmission among older adults who return home with unmet need for ADL disability. The Gerontologist, 53(3), 454–461. https://doi.org/10.1093/geront/gns103.
Dotchin, C. L., Akinyemi, R. O., Gray, W. K., & Walker, R. W. (2013). Geriatric medicine: Services and training in Africa. Age and Ageing, 42(1), 124–128. https://doi.org/10.1093/ageing/afs119.
Eliason, S., Baiden, F., Quansah-Asare, G., Graham-Hayfron, Y., Bonsu, D., Phillips, J., & Awusabo-Asare, K. (2013). Factors influencing the intention of women in rural Ghana to adopt postpartum family planning. Reproductive Health, 10(1), 1–8. https://doi.org/10.1186/1742-4755-10-34.
Garay, A. M., Hashimoto, E. M., Ortega, E. M. M., & Lachos, V. H. (2011). On estimation and influence diagnostics for zero-inflated negative binomial regression models. Computational Statistics and Data Analysis, 55(3), 1304–1318. https://doi.org/10.1016/j.csda.2010.09.019.
Ghana Statistical Service. (2013). 2010 Population & Housing Census Report: The elderly in Ghana. Accra: Ghana Statistical Service. Retrieved from http://ageafrica.com/wp-content/uploads/2016/04/2012-Population-Housing-Report-on-the-Elderly-in-Ghana.pdf.
Goldman, D., & Smith, J. P. (2011). The increasing value of education to health. Social Science and Medicine, 72(10), 1728–1737. https://doi.org/10.1016/j.socscimed.2011.02.047.
Green, C. A., & Pope, C. R. (1999). Gender, psychosocial factors and the use of medical services: A longitudinal analysis. Social Science & Medicine, 48(10), 1363–1372. https://doi.org/10.1016/S0277-9536(98)00440-7.
Griffith, L., Raina, P., Wu, H., Zhu, B., & Stathokostas, L. (2010). Population attributable risk for functional disability associated with chronic conditions in Canadian older adults. Age and Ageing, 39(6), 738–745. https://doi.org/10.1093/ageing/afq105.
Hass, Z., DePalma, G., Craig, B. A., Xu, H., & Sands, L. P. (2015). Unmet need for help with activities of daily living disabilities and emergency department admissions among older medicare recipients. The Gerontologist, 00(00), gnv142. https://doi.org/10.1093/geront/gnv142.
Jehu-Appiah, C., Aryeetey, G., Spaan, E., de Hoop, T., Agyepong, I., & Baltussen, R. (2011). Equity aspects of the National Health Insurance Scheme in Ghana: Who is enrolling, who is not and why? Social Science & Medicine, 72(2), 157–165. https://doi.org/10.1016/j.socscimed.2010.10.025.
Kakwani, N., & Subbarao, K. (2005). Ageing and poverty in Africa and the role of social pensions. Washington, D.C.: World Bank Group. http://documents.worldbank.org/curated/en/108461468194045007/Ageing-and-poverty-in-Africa-and-the-role-of-social-pensions.
Kankeu, H. T., & Ventelou, B. (2016). Socioeconomic inequalities in informal payments for health care: An assessment of the “Robin Hood” hypothesis in 33 African countries. Social Science and Medicine, 151, 173–186. https://doi.org/10.1016/j.socscimed.2016.01.015.
Khoury, A. J., Hall, A., Andresen, E., Zhang, J., Ward, R., & Jarjoura, C. (2013). The association between chronic disease and physical disability among female Medicaid beneficiaries 18–64 years of age. Disability and Health Journal, 6(2), 141–148. https://doi.org/10.1016/j.dhjo.2012.11.006.
Kissah-Korsah, K. (2008). Spatial accessibility to health care facilities in the Ajumako-Enyan-Essiam and upper Denkyira districts in the central region of Ghana. Norsk Geografisk Tidsskrift – Norwegian Journal of Geography, 62(3), 203–209. https://doi.org/10.1080/00291950802335822.
Lee, J. H., Han, G., Fulp, W. J., & Giuliano, A. R. (2012). Analysis of overdispersed count data: Application to the human papillomavirus infection in men (HIM) study. Epidemiology and Infection, 140(6), 1087–1094. https://doi.org/10.1017/S095026881100166X.
Martin, L. G., & Schoeni, R. F. (2014). Trends in disability and related chronic conditions among the forty-and-over population: 1997–2010. Disability and Health Journal, 7(1 SUPPL), S4–S14. https://doi.org/10.1016/j.dhjo.2013.06.007.
Mba, C. J. (2010). Population ageing in Ghana: Research gaps and the way forward. Journal of Aging Research, 2010. https://doi.org/10.4061/2010/672157.
Minicuci, N., Biritwum, R. B., Mensah, G., Yawson, A. E., Naidoo, N., Chatterji, S., & Kowal, P. (2014). Sociodemographic and socioeconomic patterns of chronic non-communicable disease among the older adult population in Ghana. Global Health Action, 7, 1–13. https://doi.org/10.3402/gha.v7.21292.
Mustard, C. A., Kaufert, P., Kozyrskyj, A., & Mayer, T. (1998). Sex differences in the use of health care services. New England Journal of Medicine, 338(23), 1678–1683. https://doi.org/10.1056/NEJM199806043382307.
Nakua, E. K., Otupiri, E., Dzomeku, V. M., Owusu-Dabo, E., Agyei-Baffour, P., Yawson, A. E., Folson, G., & Hewlett, S. (2015). Gender disparities of chronic musculoskeletal disorder burden in the elderly Ghanaian population: Study on global ageing and adult health (SAGE WAVE 1). BMC Musculoskeletal Disorders, 16(1), 1–10. https://doi.org/10.1186/s12891-015-0666-3.
Ogwumike, F. O., & Aboderin, I. (2005). Exploring the links between old age and poverty in Anglophone West Africa – evidence from Nigeria and Ghana. Generations Review, 15(2), 7–15.
Owen, N. (2012). Sedentary behavior: Understanding and influencing adults’ prolonged sitting time. Preventive Medicine, 55(6), 535–539. https://doi.org/10.1016/j.ypmed.2012.08.024.
Prince, M. J., Wu, F., Guo, Y., Gutierrez Robledo, L. M., O’Donnell, M., Sullivan, R., & Yusuf, S. (2015). The burden of disease in older people and implications for health policy and practice. The Lancet, 385(9967), 549–562. https://doi.org/10.1016/S0140-6736(14)61347-7.
Sarfo-Kantanka, O., Sarfo, F. S., Ansah, E. O., Eghan, B., Ayisi-Boateng, N. K., & Acheamfour-Akowuah, E. (2016). Secular trends in admissions and mortality rates from diabetes mellitus in the central belt of Ghana: A 31-year review. PLoS One, 11(11), 1–14. https://doi.org/10.1371/journal.pone.0165905.
Sarfo, F. S., Akassi, J., Awuah, D., Adamu, S., Nkyi, C., Owolabi, M., & Ovbiagele, B. (2015). Trends in stroke admission and mortality rates from 1983 to 2013 in Central Ghana. Journal of the Neurological Sciences, 357(1–2), 240–245. https://doi.org/10.1016/j.jns.2015.07.043.
Sarfo, F. S., Awuah, D. O., Nkyi, C., Akassi, J., Opare-Sem, O. K., & Ovbiagele, B. (2016). Recent patterns and predictors of neurological mortality among hospitalized patients in Central Ghana. Journal of the Neurological Sciences, 363, 217–224. https://doi.org/10.1016/j.jns.2016.02.041.
Sarpong, N., Loag, W., Fobil, J., Meyer, C. G., Adu-Sarkodie, Y., May, J., & Schwarz, N. G. (2010). National health insurance coverage and socio-economic status in a rural district of Ghana. Tropical Medicine and International Health, 15(2), 191–197. https://doi.org/10.1111/j.1365-3156.2009.02439.x.
Sato, A. (2012). Does socio-economic status explain use of modern and traditional health care services? Social Science and Medicine, 75(8), 1450–1459. https://doi.org/10.1016/j.socscimed.2012.05.032.
Schillinger, D., Barton, L. R., Karter, A. J., Wang, F., & Adler, N. (2006). Does literacy mediate the relationship between education and heath outcomes? A study of a low income population with diabetes. Public Health Reports, 121(3), 245–254.
Sheu, M. L., Hu, T. W., Keeler, T. E., Ong, M., & Sung, H. Y. (2004). The effect of a major cigarette price change on smoking behavior in California: A zero-inflated negative binomial model. Health Economics, 13(8), 781–791. https://doi.org/10.1002/hec.849.
Stamatakis, E., Davis, M., Stathi, A., & Hamer, M. (2012). Associations between multiple indicators of objectively-measured and self-reported sedentary behaviour and cardiometabolic risk in older adults. Preventive Medicine, 54(1), 82–87. https://doi.org/10.1016/j.ypmed.2011.10.009.
StataCorp. (2013). Stata base reference manual – release 13. College Station: Stata Press.
Tenkorang, E. Y., & Kuuire, V. Z. (2016). Noncommunicable diseases in Ghana: Does the theory of social gradient in health hold? Health Education & Behavior, 43(1 Suppl), 25S–36S. https://doi.org/10.1177/1090198115602675.
United Nations Department of Economic and Social Affairs, P. D. (2015). World population ageing 2015. New York: United Nations (ST/ESA/SER.A/390).
Witter, S., & Garshong, B. (2009). Something old or something new? Social health insurance in Ghana. BMC International Health and Human Rights, 9, 20. https://doi.org/10.1186/1472-698X-9-20.
Xu, H., Covinsky, K. E., Stallard, E., Thomas, J., III, & Sands, L. P. (2012). Insufficient help for activity of daily living and risk of all-cause hospitalization. Journal of the American Geriatrics Society, 60(5), 927–933. https://doi.org/10.1016/j.biotechadv.2011.08.021.Secreted.
Zimmer, Z., & Das, S. (2014). The poorest of the poor: Composition and wealth of older person households in sub-Saharan Africa. Research on Aging, 36(3), 271–296. https://doi.org/10.1177/0164027513484589.
Zuur, A. F., Leno, E. N., Walker, N. J., Saveliev, A. A., & Smith, G. M. (2009). Mixed effects models and extensions in ecology with R. In M. Gail, K. Krickeberg, J. M. Samet, A. Tsiatis, & W. Wong (Eds.), Statistics for biology and health. New York: Springer. https://doi.org/10.1007/978-0-387-87458-61.
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We are also grateful to the WHO SAGE group for the data used in this study.
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Amegbor, P.M., Rosenberg, M.W. Health and socioeconomic risk factors for overnight admission among older adults in Ghana. Population Ageing 15, 961–979 (2022). https://doi.org/10.1007/s12062-020-09294-3
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DOI: https://doi.org/10.1007/s12062-020-09294-3