Do the determinants of health differ between people living in the community and in institutions?

Determinants of health studies have mainly dealt with samples of community-dwelling subjects. We utilized the 1996/97 Canadian National Population Health Survey community and institutional surveys to identify factors associated with the selection of individuals to institutions. We also assessed whether the same determinants of health variables explain variations in health in those living in the community and those living in institutions. Logistic regression analysis was used to investigate factors associated with selection to institutions. Results showed that health status, age, chronic conditions, education, race, marital status, smoking and alcohol were associated with the probability of being in an institution. Multiple linear regression analyses (dependent variable: Health Utilities Index Mark 3 [HUI3] score) with individual characteristics, socio-economic status, and health risk factors were also estimated. Results showed that advanced age, higher number of chronic conditions, lower education, smoking and being an alcohol non-drinker were negatively and significantly associated with HUI3 scores for the community sample. Except for age, chronic conditions and being an alcohol non-drinker, none of these factors were significantly associated with HUI3 for the institutional sample. Moreover, the association between age and HUI3 was weaker for the institutional sample in comparison to the community sample. Implications are that, for those who are institutionalized, the usual determinants of health factors are less important. In conclusion, there appears to be important heterogeneity in determinants of health between persons living in the institution and community.