Women with Asthma: Asthma health care utilization associated with

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Women with Asthma: Asthma health care utilization associated with Powered By Docstoc
					Women’s Self-
Management of Asthma
Noreen Clark, PhD
Molly Gong, MD
Melissa Valerio, MPH
Sijian Wang, BS
Xihong Lin, PhD
William Bria, MD
Timothy Johnson, MD

University of Michigan
School of Public Health
Background

 Approximately 9.6 million women had
  asthma in 2001 compared to an
  estimated 5 million men (CDC, 2002).

 Asthma disproportionately affects boys
  and women. Increases in the rate of
  asthma in women begin in adolescence
  (references)
Purpose

To examine demographic factors
 and symptoms associated with
 asthma self-management in
 women with asthma.
Study Participants

  652 women
  18 years and older

  Physician diagnosis

  Attending University of Michigan
   Asthma & Airways Clinic and
   University of Michigan Health
   System
Data collection

Telephone interview

   Demographics

   Asthma  symptoms
   Health care utilization

   Gender-related management

   Peak flow meter use
Data Analyses


Logistic regression and
Odds Ratios (OR) or
Relative Risk (RR) were
computed.
Demographics: Age

       7%   9%

 13%

                   21%   18-30
                         31-40
                         41-50
                         51-60
24%
                         61-70
                         >71
             26%
Demographics: Education

       2%
 22%
             26%

                   < High School

                   High School

                   2-year College

                   4-year College

                   Post Grad
29%
            21%
  Demographics: Income

      11%    5%
                  6%          <10,000
                              10,001-20,000
15%                     16%   10,001-20,000
                              40,001-60,000
                              60,001-80,000
                              80,000-100,000
13%
                       18%    >100,000
                              Not reported
       16%
      Demographics: Race/Ethnicity


                 83%
2%                      Caucasian/White

1%                      African American/Black
2%                      Asian/Pacific Islander
2%
                        Hispanic/Latino
10%
                        Native American

                        Other
Findings
                          Asthma Severity

                                                    Percent of Women
 Mild intermittent                                               52%

 Mild persistent                                                 15%

 Moderate persistent                                             18%

 Severe persistent                                               15%

Classified by NAEPP criteria, Guidelines and Diagnosis and Treatment of Asthma, 1997
   Demographics and Persistent
           Asthma
                        OR         P-value
    Low income         1.76         .026
   Less education      1.68         .003
    Unemployed         1.71         .002
       Race            0.546        .0073
     Marriage          1.095        .5773

 Women of minority, low income, less
  education, and unemployed were more likely
  to have persistent asthma
PFM use and Persistent Asthma

Results from logistic
 regression indicated that
 women with persistent
 asthma used more peak flow
 meters (OR=1.48, p=.03)
Management Behavior and
Persistent Asthma
 Results from Poisson regression type-3
  test indicated that women with more
  severe asthma were more likely to adopt
  management techniques (p=.0001).
 However, women’s beliefs about self-
  management and confidence in
  management behavior were not
  associated with their disease severity
  (p>.05)
 Demographics and Frequency of Using
    The Management Techniques

                     RR              P-value
    Married         1.0103            .6830
  Low income        1.0658            .0810
     Race           0.9480            .1041
   Education        0.9204            .0014
  unemployed        1.0999            .0003

 Lower education level and unemployment
  were associated with more use of
  management techniques.
Demographics and Believes of The
Management Techniques
                     RR             P-value
    Married         1.0163           .3740
  Low income        0.9996           .9887
     Race           0.9923           .7524
   Education        0.9546           .0141
  unemployed        0.9680           .937
 Lower education level was associated with
  higher level of belief in the management
  techniques.
Demographics and Confidence of
Using the Management Techniques
                    RR            P-value
   Married         1.0245          .1930
 Low income        0.9823          .5278
    Race           0.9577          .0766
  Education        0.9480          .0058
 unemployed        1.0411          .0413

 Lower education level and unemployment
  were associated with higher level of
  confidence in using the management
  techniques.
Hormone Related Findings

 49% women currently menstruate.
  Among those, 16% noticed symptoms
  worsening during the week prior to
  the period, 97% women reported at
  least one PMS symptom.
 36% women reported they were
  bothered by symptoms of asthma
  during sexual activity.
Menstruation and Health Care Use

                        RR         P-value
    hospitalization    1.42         0.02
     ED visits         1.04         >.05
 Unscheduled visits    1.01         >.05
  Scheduled visits     1.29         .0056
  Follow-up visits     1.06         >.05

 Women who menstruate had significantly
  more hospitalizations and scheduled doctor
  visits.
PMS and Asthma Health Care Use

                        RR          P-value
     hospitalization    4.95         .0007
      ED visits         1.79         .025
 Unscheduled visits     2.01         .002
  Scheduled visits      1.23          .38
   Follow-up visits     1.81         .007

 Women who reported PMS Symptoms had
 more hospitalizations, ED visits,
 unscheduled doctor visits and doctor visits
 to follow-up an asthma episode
   With Problems during Sexual
   Activity and Health Care Use
                       RR     P-value
     hospitalization   1.42     .006
      ED visits        1.51    .0001
  Unscheduled visits   1.46    .0001
   Scheduled visits    1.23    .0045
   Follow-up visits    1.32    .0001


 Women who reported asthma related
 problems during sexual activity had
 significantly more health care use.
Study Limitations

The study sample includes a
number of women with high
levels of education and
income and an average age
of 51 years.
Conclusions

 Health care use maybe associated
  with sex and gender related
  management problems for women
  with asthma.

 Severity of asthma is associated with
  use of more management techniques
  including peak flow meter usage.

				
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posted:8/30/2012
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