Women's Health Highlights: Recent Findings

Cervical Cancer

• Despite new guidelines, most ob-gyns continue to over-screen low-risk women for cervical cancer.

  The American Cancer Society suggests that cervical cancer screening with Pap tests begin within 3 years after a woman becomes sexually active or by age 21, whichever comes first. The ACS no longer recommends annual screening in women over age 30 who have had three or more previous normal Pap tests. The American College of Obstetricians and Gynecologists has made similar recommendations. Yet, 185 randomly selected ob-gyns said that they would begin screening girls who were not yet sexually active at age 18. Also, 60 percent of respondents said that they would continue annual screening in a 35-year-old woman with three or more normal tests.

  Saint, Gildengorin, and Sawaya, Am J Obstet Gynecol 192:414-21, 2005 (AHRQ grant HS07373).

• Less frequent cervical cancer screening may be a safe option.

  Current care guidelines recommend extending the interval for Pap tests from once a year to once every 3 years among low-risk women with three consecutive negative pap tests. According to this study, the less-frequent approach is a safe option with only minimal excess risk of cervical cancer in women aged 30 to 64.

  Sawaya, McConnell, Kulasingam, et al., New Engl J Med 349(16):1501-9, 2003 (AHRQ grant HS07373).

• Rural women report satisfaction with telecolposcopy.

  Women living in rural Georgia felt that telecolposcopy saved them time and money and said they would recommend the procedure to a friend. The women believed that telecolposcopy improved the quality of their care, and they felt better about their health after the exam.

  Ferris, Litaker, and Lopez, J Am Board Fam Pract 16:405-11, 2003 (HS08814).

• Cervical cancer rates among younger women have decreased.

  According to this study, the rate of cervical cancer detected among women younger than 30, incidence rates of cervical cancer overall and squamous cell cancer specifically declined by nearly 1 percent per year from 1973 to 1999.

  Chan, Sung, and Sawaya, Obstet Gynecol 102(4):765-73, 2003 (AHRQ grant HS07373).

• South Asian women should be targeted to receive cervical cancer screening.

  Despite the high socioeconomic status of Indian and other South Asian women living in the United States, this study found that one-fourth of them had not had a Pap smear in more than 3 years. Regions with large South Asian populations should be targeted with messages promoting cervical cancer screening. The message should be aimed particularly at unmarried South Asian women of low socioeconomic status who have spent little time in America.

  Chaudhry, Fink, Gelberg, and Brook, J Gen Intern Med 18:377-84, 2003 (AHRQ grant HS10597).

• Telecolposcopy can enhance diagnostic accuracy.

  Researchers examined the efficacy of telecolposcopy for women with abnormal Pap smears or other indications for colposcopy who were examined by local colposcopists at rural clinics. Images of colposcopic examinations were transmitted to a tertiary care center for interpretation by an expert colposcopist and to an expert at the rural site. The colposcopists did not share findings with each other. Agreement ranged from 60, 56, and 53 percent for the local colposcopists, distant experts, and site experts, respectively.

  Ferris, Macfee, Miller, et al., Obstet Gynecol 99(2):248-54, 2002 (AHRQ grant HS08814).

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Breast and Cervical/Ovarian Cancer

• Task Force recommends against routine testing for genetic risk of breast or ovarian cancer.

  According to the U.S. Preventive Services Task Force, primary care physicians should only refer certain women for genetic counseling and DNA testing to detect the presence of specific BRCA1 and BRCA2 gene mutations that may be associated with breast and ovarian cancer. Physicians should suggest counseling and DNA testing only for women who have specific family history patterns which put them at risk for these gene mutations.

  Nelson, Huffman, Fu, and Harris, Ann Intern Med 143(5):362-79; see also pages 355-61 in the same journal (AHRQ contract 290-97-0011).

• Physician specialty influences use of screening mammography and Pap smears in gatekeeper plans.

  The impact of gatekeeper plans—which require a referral to see a specialist—on cancer screening varies according to the specialty of a woman's primary care physician, according to this study. For example, the use of mammography to screen for breast cancer and Pap smears to screen for cervical cancer among patients of internal medicine physicians were unaffected by enrollment in a gatekeeper plan. On the other hand, screening rates were increased if family practice physicians were in gatekeeper plans. The researchers note that different cultures of practice may explain the study findings.

  Haggstrom, Phillips, Liang, et al., Cancer Causes and Control 15:883-92, 2004 (AHRQ grant HS10771 and HS10856).

• Breast and cervical cancer screening rates are higher in areas with greater HMO market share.

  After taking into account individual and area factors, women in high HMO market share areas were nearly twice as likely to have recently had a mammogram or Pap smear, according to this study. Also, women were 58 percent more likely to have had a recent clinical breast exam than women in areas with low managed care penetration. Also, there was a spillover effect to women not enrolled in managed care. The researchers linked data on cancer screening from the 1996 Medical Expenditure Panel Survey with data on HMO market share and HMO competition in metropolitan statistical areas.

  Baker, Phillips, Haas, et al., Health Serv Res 39(6, part I):1751-72, 2004 (AHRQ grants HS10771, HS10856, and HS10925).

• Personalized form letters may improve breast and cervical cancer screening among some women.

  According to this study of more than 1,500 urban low-income and minority women, sending them a personalized form letter with general cancer information increases the likelihood they will be screened for cervical and breast cancer.

  Jibaja-Weiss, Volk, Kingery, et al., Patient Educ Couns 50:123-32, 2003 (AHRQ grant HS08581).

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Other Cancers

• Screening sigmoidoscopy may be less effective for detecting colorectal cancer in women and older people.

  This study found that screening for colorectal cancer with a 60-cm flexible sigmoidoscope resulted in inadequate exams for 18 percent of patients of all ages. The percentage of inadequate exams increased progressively with age, from 10 percent for ages 50 to 59 to 22 percent for ages 80 or older. Inadequate exams were more common in women of all ages, ranging from 19 percent (ages 50-59) to 32 percent (ages 80 and older). Women are more likely than men to experience pain during the exam, and they have longer colons in a smaller abdominal cavity.

  Walter, deGarmo, and Covinsky, Am J Med 116:174-8, 2004 (AHRQ grant K02 HS00006).

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Hysterectomy and Other Treatments for Uterine Conditions

More than 500,000 hysterectomies are performed in the United States each year at an annual cost of more than $5 billion. More than one-third of women in the United States have had a hysterectomy by age 60.

The most common reason for hysterectomy for women of any age continues to be fibroid tumors, which in the mid-1990s accounted for about one-third of all hysterectomies (nearly two-thirds for black women). Other reasons for hysterectomy include endometriosis (about 18 percent), uterine prolapse (16 percent), excessive bleeding (5 percent), and other causes (10 percent).

• Type of hysterectomy does not affect sexual functioning and quality of life 2 years later.

  Women who undergo supracervical hysterectomy (cervix is left in place) or total abdominal hysterectomy (cervix is removed) achieve similar sexual functioning and quality of life 2 years after the procedure, according to this study of 135 premenopausal women who underwent hysterectomy in one of four U.S. clinical centers. At 6 months postsurgery, sexual problems had improved dramatically in both groups, and at 2 years the women reported few problems in this area. Both groups also had substantial improvement in most other quality of life measures.

  Kuppermann, Summit, Varner, et al., Obstet Gynecol 105(6):1309-18, 2005; see also Learman, Summitt, Varner, et al., Obstet Gynecol 102:453-62, 2003 (AHRQ grant HS09478).

• Hysterectomy offers better outcomes than medicine for women with abnormal uterine bleeding.

  This randomized controlled trial of women aged 30 to 50 who had abnormal uterine bleeding for an average of 4 years found that those in the hysterectomy group had greater improvement in their symptoms and expressed higher satisfaction with their overall health 6 months after treatment than women in the oral medication group.

  Kuppermann, Varner, Summitt, et al., JAMA 291(12):1447-55, 2004 (AHRQ grant HS07373).

• Long-term outcomes are similar for women who either have a hysterectomy or go through natural menopause.

  This is the first study to examine the long-term impact of hysterectomy on quality of life. The researchers found no difference in quality of life between women who had a hysterectomy (with or without ovary removal) an average of 27 years earlier and women who had a natural menopause 25 years earlier. The study involved 801 women aged 50-96 who were interviewed between 1992 and 1996.

  Kritz-Silverstein, Von Muhlen, Ganiats, and Barrett-Connor, Qual Life Res 13:55-62, 2004 (AHRQ grant HS06726).

• Several factors influence women's satisfaction with use of medication to treat abnormal uterine bleeding.

  Factors such as age, fertility status, attitudes about uterine conservation, and intensity of symptoms affect premenopausal women's satisfaction with use of oral medroxyprogesterone acetate to control bleeding.

  Richter, Learman, Lin, et al., Am J Obstet Gynecol 189:37-42, 2003 (AHRQ grant HS9478).

• Study finds racial differences in treatment and outcomes of women undergoing surgery for uterine fibroids.

  The researchers examined the medical charts of 225 women (53 percent black, 47 percent white) who underwent abdominal myomectomy for fibroid tumors at one medical center between 1992 and 1998. Black women were more than twice as likely as white women to have in-hospital complications or a blood transfusion. These increased complications were largely due to differences in uterine size and number of fibroids.

  Roth, Gustilo-Ashby, Barber, and Myers, Obstet Gynecol 101:881-4, 2003 (AHRQ grant HS09874).

• Endometrial ablation does not substitute for hysterectomy.

  Using the State Inpatient and Ambulatory Surgery Databases of the Healthcare Cost and Utilization Project, investigators accessed data on women with benign uterine conditions who underwent hysterectomy or endometrial ablation. In the six States studied, from 1990 to 1997, increases in endometrial ablation rates did not mirror decreases in hysterectomy rates. Results show endometrial ablation was used as an additive medical technology rather than as a substitute for hysterectomy.

  Farquhar, Naoom, and Steiner, Int J Technol Assess Health Care 18(3):625-34, 2002. (Reprints, AHRQ Publication No. 03-R004).*

• Study shows life satisfaction improves after hysterectomy.

  In a 1992 survey, women were asked to rate their life satisfaction as better, the same, or worse after menopause or hysterectomy. Women who were 20 or more years posthysterectomy or postmenopause were significantly more likely to reply "better" than women 5 or fewer years after these events. Among women with a hysterectomy, 53 percent with oophorectomy and 60 percent with ovarian conservation rated life better after the surgery. Only 42 percent of women who had not had a hysterectomy rated life satisfaction as better after menopause.

  Kritz-Silverstein, Wingard, and Barrett-Connor J Womens Health and Gender-Based Med 11(2):181-90, 2002 (AHRQ grant HS06726).

• U.S. hysterectomy rates stayed constant but the type of surgery changed.

  An analysis of 1990-1997 hospital discharge data from the Nationwide Inpatient Sample of the Healthcare Cost and Utilization Project revealed that over the study period, rates of hysterectomy for benign uterine conditions remained about the same, abdominal hysterectomy remained the most common procedure, and laparoscopic hysterectomies increased 30-fold.

  Farquhar and Steiner, Obstet Gynecol 99(2):229-34, 2002. (Reprints, AHRQ Publication No. 02-R049)* (Intramural).

• Study reveals effects of hysterectomy on UI.

  Using the Urinary Symptom Scale for Women, researchers interviewed 1,299 women to assess incontinence before and after hysterectomy. Responses indicate that UI improves for the first 2 years after surgery for most women who have moderate or severe incontinence. According to researchers, women who had mild or no incontinence before hysterectomy had a 10 percent risk of worse or new-onset incontinence after surgery.

  Kjerulff, Langenberg, Greenaway, et al., J Urol 167:2088-92, 2002 (AHRQ grant HS06865).

• Report describes evidence on management of uterine fibroids.

  Researchers at the Duke EPC reviewed the available evidence on the commonly used medical and invasive therapies for uterine fibroids and found the overall quality of the literature to be poor and inconsistent. They did, however, find good evidence that use of gonadotropin-releasing hormone agonists prior to surgery reduces blood loss and may facilitate certain surgical approaches (e.g., use of laparoscopic or vaginal approaches or use of transverse abdominal instead of vertical incisions). They also found that 2-year outcomes are favorable for most women who undergo hysterectomy.

  Copies of Evidence Report/Technology Assessment No. 34, Management of Uterine Fibroids (AHRQ Publication No. 01-E051 summary and 01-E052, full report), are available from AHRQ (contract 290-97-0014).*

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Reproductive Health

AHRQ's research on reproductive health focuses on fertility problems, use of contraceptives, chronic pelvic pain, and conditions that can affect fertility and childbearing.

Pelvic inflammatory disease (PID) is one of many health conditions that can affect women during their reproductive years. PID affects more than 1 million U.S. women each year and frequently results in infertility, ectopic pregnancy, and chronic pelvic pain. Annual estimated costs associated with PID and its consequences exceed $4 billion.

• Uterine artery embolization found to be a low-risk procedure.

  Researchers examined the outcomes of more than 3,000 women who underwent uterine artery embolization for fibroids. The women were treated at 72 sites across the United States. Overall, less than 1 percent of women suffered from major inpatient complications; 4.8 percent suffered from major events (mostly inadequate pain relief ) within the first 30 days following hospital discharge. There were no deaths related to the procedure, but 31 women required additional surgical intervention with 30 days of the procedure.

  Worthington-Kirsch, Spies, Myers, et al., Obstet Gynecol 106(1):52-9, 2005; see also pp. 44-51 by the same authors in the same journal (AHRQ grant HS09760).

• Certain factors predict chronic pelvic pain after PID.

  One-third of women with PID subsequently suffer from chronic pelvic pain. A study of 780 urban women with PID found that women who smoked, those who had previous episodes of PID, women who were married, and those who had low mental health scores were more likely than other women to experience chronic pelvic pain. The researchers also note that recurrent PID can cause adhesions to form and may represent persistent, chronic infection or inflammation, all of which can result in chronic pelvic pain.

  Haggerty, Peipert, Weitzen, et al., Sex Trans Dis 32(5):293-9, 2005; see also Haggerty, Schulz, Ness, et al., Obstet Gynecol 102:934-9 (AHRQ grant HS08358).

• Women who have urinary incontinence are more likely than those with pelvic organ prolapse to complain of sexual problems.

  Pelvic floor disorders—including urinary incontinence (UI) and pelvic organ prolapse—affect nearly one-third of adult women. Researchers at Johns Hopkins University examined the association between pelvic floor disorders and sexual complaints using data collected in 1992-1993 during in-home interviews of 1,299 women aged 30 to 50 who were scheduled to undergo hysterectomy. Nearly 40 percent of the women had evidence of pelvic floor disorders. UI was associated with twice the likelihood of low libido, vaginal dryness, and painful intercourse, independent of a woman's age, education, or race. In contrast, pelvic organ prolapse was not associated with sexual problems.

  Handa, Harvey, Cundiff, et al., Am J Obstet Gynecol 191:751-6, 2004 (AHRQ grant HS06865).

• Drug regimens for treating PID should include metronidazole.

  In a recent study of 278 women with clinically suspected PID, researchers frequently isolated bacteria that are strongly associated with endometritis. This finding prompted them to recommend that all women with PID be treated with drug regimens that include the broad-spectrum antibiotic, metronidazole. They conclude that this approach could potentially reduce the frequency of infertility, chronic pelvic pain, recurrent PID, and ectopic pregnancy after treatment.

  Haggerty, Hillier, Bass, et al., Clin Infect Dis 39:990-5, 2004 (AHRQ grant HS08358).

• Targeted chlamydia screening found to be most effective and cost effective.

  Annual screening for chlamydia of all sexually active women aged 15 to 29, coupled with semiannual screening of those with a history of chlamydial infection, is the most effective and cost-effective screening strategy, according to this study. Since most chlamydial infections are asymptomatic and are 100 percent curable if caught early, screening and early treatment are critical.

  Hu, Hook, and Goldie, Ann Intern Med 141:501-13, 2004 (AHRQ grant T32 HS00020).

• Many women face barriers to consistent use of oral contraceptives.

  Uninterrupted use of oral contraceptive pills is necessary for optimal effectiveness. For some women, out-of-pocket costs and the inconvenience of making monthly pharmacy visits may be barriers to consistent use of oral contraceptives, according to this study.

  Phillips, Stotland, Liang, et al., JAMA 59:36-42, 2004 (AHRQ grants HS10771 and HS10856).

• Researchers examine effects of condom use on recurrent PID.

  In this study of 684 sexually active women with PID, consistent condom users had 50 percent less risk of recurrent PID compared with inconsistent users of condoms. Other barrier methods, such as diaphragms and use of oral contraceptives, had no effect on risk of recurrent PID.

  Ness, Randall, Richter, et al., J Public Health 94(8):1327-9, 2004 (AHRQ grant HS08358).

• Research findings suggest that invasive prenatal diagnostic testing should be offered to all women.

  Current guidelines recommend offering noninvasive screening tests (blood tests and/or ultrasound) to pregnant women younger than 35 and reserving invasive diagnostic testing (amniocentesis and chorionic villus sampling) for women age 35 or older and those at elevated risk for having a child with a genetic disorder. Two recent studies disagree. The first study recommends that prenatal diagnostic testing be offered to all women, not just those at elevated risk. The second study concludes that prenatal diagnostic testing can be cost effective at any age or risk level.

  Caughey, Washington, Gildengorin, and Kuppermann, Obstet Gynecol 103:539-45, 2004 (AHRQ grant HS07373); and Harris, Washington, Nease, and Kuppermann, Lancet 363:276-82, 2004 (AHRQ grant HS07373).

• Endometritis does not predict reproductive problems after PID.

  In a study that involved 614 women, the researchers compared women with endometritis, upper genital tract infection (gonorrhea or chlamydia), or both to women without these problems for outcomes of pregnancy, infertility, recurrent PID, and chronic pelvic pain. For women with mild to moderate PID who were treated with standard antibiotics, endometritis and/or infection were not associated with reduced pregnancy, elevated infertility, or recurrent PID.

  Haggerty, Ness, Amortegui, et al., Amer J Obstet Gynecol 188:141-8, 2003 (AHRQ grant HS08358)

• Inpatient and outpatient PID treatment outcomes are similar.

  Researchers compared the effectiveness of inpatient and outpatient treatment strategies in preserving fertility and preventing recurrence of PID, chronic pelvic pain, and ectopic pregnancy for women with mild to moderate PID. After 35 months, pregnancy rates were nearly equal between the groups. There were no significant differences between the proportion of women with ectopic pregnancy, chronic pelvic pain, or PID recurrence.

  Ness, Soper, Holley, et al., Am J Obstet Gynecol 186(5):929-37, 2002 (AHRQ grant HS08358).

• Contraception affects risk of upper genital tract infection.

  Researchers interviewed and obtained endometrial samples from 14- to 37-year-old females with PID to examine the link between hormonal and barrier contraception on the development of UGTI. About 60 percent of the women were age 24 or younger, and nearly 63 percent of the women were black. Although inconsistent use of condoms was associated with a two to three times greater risk of UGTI, no contraceptive method significantly reduced UGTI.

  Ness, Soper, Holley, et al., Am J Obstet Gynecol 185:121-7, 2001 (AHRQ grant HS08358).

• Researchers evaluate use of clinical predictors of endometritis in women with symptoms of PID.

  Adnexal tenderness (tenderness of the ovaries and/or fallopian tubes) identifies over 95 percent of women with PID, but only 83 percent are identified by the minimum criteria for diagnosing PID suggested by the Centers of Disease Control and Prevention. These and other findings are based on the characteristics of 651 women enrolled in a multicenter randomized treatment trial for PID, clinical and laboratory findings, and endometrial sampling.

  Peipert, Ness, Blume, et al., Am J Obstet Gynecol 184:856-64, 2001 (AHRQ HS08358).

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Health Care Access, Quality, and Costs

The many changes taking place in health care delivery in the United States have serious implications for women's health. These changes include a consolidation of the health care system, a shift to managed care, and decreased public funding of health care and health-related programs. These changes mean woman need more information than ever before to help them make informed health care choices for themselves and their families.

• Physician specialty linked to patient satisfaction among younger women.

  Younger women (aged 18 to 34) are more satisfied with their health care when a reproductive health specialist is the primary provider, according to this study of more than 1,100 women who made primary care visits in 2001. The researchers defined reproductive health specialists as obstetrician/gynecologists and nurse midwives. They found increased satisfaction with health care coordination and comprehensiveness of care among younger women seen by these providers.

  Henderson and Weisman, Med Care 43(8):826-33, 2005 (HS10237).

• Study finds link between State policies and women's mortality rates for certain diseases.

  Researchers at Oregon Health & Science University examined State policies affecting women's health in four areas: reproductive issues (e.g., State requirements for private insurers to cover cervical cancer screening), economic issues (e.g., child support payments), access to care (e.g., Medicaid eligibility requirements), and ensuring healthy communities (e.g., gun control and aid to victims of domestic violence). They found that Medicaid eligibility policies accounted for 66 percent of the variation in heart disease mortality across States. Policies related to violence against women and gun control, family medical support and efforts to expand Medicaid, and tracking of environmental health accounted for 50 percent of the variance in lung cancer mortality.

  Wisdom, Berlin, and Lapidus, Soc Sci Med 61:1776-84, 2005 (AHRQ grant T32 HS00069).

• Informal caregivers influence hospitalization of elderly women.

  The researchers analyzed data from a sample of 420 disabled elderly women who were receiving informal care from family and friends. The objective was to examine the relationship between caregiver attributes and the women's hospitalization experiences. Results showed that the women were more likely to be hospitalized but less likely to have a delayed discharge if their caregivers felt competent in their role. Nearly half of the women were never hospitalized over 3 years. Those who were hospitalized tended to be older, were in worse health, had more task limitations, and had a cardiopulmonary condition or diabetes.

  Wolff and Kasper, Aging Clin Exp Res 16(4):307-13, 2004 (AHRQ grant T32 HS00029).

• Inequalities in care continue to limit women's access to the most effective therapies.

  In this article, AHRQ's Senior Advisor on Women's Health identifies five key areas for advancing women's health: research, clinical practice, policy, curriculum development, and research training. Studies that focus separately on women and men are needed to develop targeted quality measures and other initiatives that address the unique health care needs of women.

  Correa-de-Araujo, Women's Health Issues 14:31-4, 2004 (Reprints, AHRQ Publication No. 04-R044)* (Intramural).

• Racial disparities found in Medicare managed care plans.

  Data from the 1998 Medicare Health Plan Employer Data and Information Set on 305,574 elderly patients enrolled in Medicare managed care health plans revealed racial differences in clinical services. For example, blacks were less likely than whites to receive breast cancer screening (63 vs. 71 percent). Researchers said more than half of this disparity was explained by socioeconomic factors.

  Schneider, Zaslavsky, and Epstein, JAMA 287(1):1288-94, 2002 (AHRQ grant HS10803).

• Disparities in men's and women's mental health may be sociodemographic.

  Using the 12-item General Health Questionnaire with men and women working in three organizations in the United Kingdom, researchers found that women had more minor mental health problems than men. However, in each organization, women were overrepresented in the lowest grades and underrepresented in the higher grades. Studies of differences between men and women in mental health should take into account their work and life situations.

  Emslie, Fuhrer, Hunt, et al., Soc Sci Med 54:621-4, 2002 (AHRQ HS06516).

• Lack of prenatal coverage decreases chances for timely care.

  This study examined the relationship between timing of insurance coverage and prenatal care among 5,455 low-income women. Rates of untimely prenatal care were highest among women who were uninsured throughout their pregnancy or whose coverage began after the first trimester and were lowest among women who obtained coverage during the first trimester.

  Egerter, Braveman, and Marchi, Am J Public Health 92(3):423-7, 2002 (AHRQ HS07910).

• Medicare fees influence choice of breast cancer treatment.

  Investigators used data from Medicare files, the American Hospital Association's Annual Survey of Hospitals, and the 1990 census to investigate whether Medicare fees for breast-conserving surgery (BCS) and mastectomy (MST) affected the rate of BCS across 799 ZIP code areas. Results show a that a 10 percent higher BCS Medicare fee was associated with a 7 to 10 percent higher BCS rate. A 10 percent higher MST fee was associated with a 2 to 3 percent lower proportion of women receiving BCS.

  Hadley, Mitchell, and Mandelblatt, Med Care Res Rev 58(3):334-60, 2001 (AHRQ grant HS08395).

• AHRQ fact book answers questions on hospital care for women.

  Using Healthcare Cost and Utilization Project (HCUP) data, researchers describe the care of women in U.S. hospitals in 2000 for the following categories: age, charges, length of stay, in-hospital deaths, insurance coverage, and obstetric care.

  Jiang, Elixhauser, Nicholas, et al., Care of Women in U.S. Hospitals, 2000, HCUP Fact Book No. 3 (AHRQ Publication No. 02-0044).*

• Researchers describe U.S. women's health status.

  Using 1996 MEPS data, this report describes the health status of U.S. women (perceived health, mental health, and presence of limitations) and their insurance status. Information is presented on women's usual source and type of care as a way to examine access to care.

  Altman and Taylor, Women in the Health Care System: Health Status, Insurance, and Access to Care, MEPS Research Findings 17 (AHRQ Publication No. 02-0004).*

• A new report illustrates health disparities and gaps between men and women.

  Based on data from the MEPS Household Component and the 1987 National Medical Expenditure Survey, this report presents estimates of health insurance, access to and use of care, and health status among women of different racial and ethnic groups in the United States, as well as differences between men and women.

  Kass-Bartelmes, Altman, and Taylor, Disparities and Gender Gaps in Women's Health, 1996: MEPS Chartbook No. 8 (AHRQ Publication No. 02-0003).*

• Health plan satisfaction survey finds small differences between the sexes.

  Using the Consumer Assessment of Health Plans Study (CAHPS®) adult questionnaire, researchers interviewed nearly 100,000 men and women enrolled in 206 commercial managed care plans nationwide about satisfaction with their health plans. Results show small differences by sex in satisfaction, with no consistent pattern of one sex being more satisfied than the other. Health plan characteristics accounted for the largest variation in satisfaction, and not-for-profit plan status and lower turnover of primary care providers were stronger determinants of women's satisfaction.

  Weisman, Henderson, Schifrin, et al., Women's Health Issues 11(4):401-15, 2001. (Reprints, AHRQ Publication No. 02-R007)* (Intramural).

• Race, income, and education influence older women's health.

  A survey of the health and functional status of 91,314 elderly women enrolled in Medicare managed care plans revealed that poorer and less educated women reported poorer health, experienced more chronic illness, and felt depressed or sad more of the time in the past year than their more affluent and educated counterparts. The percentages of women reporting fair or poor health were: black (46), Hispanic/Spanish (42), American Indian/Alaska Native (36), Asian/Pacific Islander (28), and white (27).

  Bierman, Haffer, and Hwang, Health Care Financing Rev 22(4):187-98, 2001 (Reprints, AHRQ Publication No. 02-R006)* (Intramural).

• Survey data reveal health disparities among older women.

  Survey data were collected from 91,314 elderly women for a new quality measure in the Health Plan Employer Data and Information Set to assess functional outcomes in Medicare+Choice plans. Over half of the women surveyed suffered from three or more chronic conditions. Women with low income, less education, and minority group status were significantly more likely than other women to suffer from chronic diseases and limited ability to function.

  Bierman and Clancy, J Amer Med Womens Assoc 56:155-60, 2001. (Reprints, AHRQ Publication No. 02-R023)* (Intramural).

• Some disabled women face barriers to screening services.

  Researchers analyzed National Health Interview Survey data with Disability, Family Resources, and Healthy People 2000 supplements to examine the use of screening and preventive services among adult women with disabilities living in the community. Women with major lower extremity disability were much less likely than other women to receive Pap smears, mammograms, and clinician inquiries about smoking.

  Iezzoni, McCarthy, Davis, et al., Am J Med Qual 16(4):135-44, 2001 (AHRQ grant HS10223).

• Researchers examine the role of ob-gyns as primary care providers for elderly women.

  Using Medicare claims data, researchers examined the degree to which ob-gyns in the State of Washington offered primary care to elderly women in 1994. About 12 percent of visits by elderly women to ob-gyns involved nongynecologic diagnoses. Further, patients who saw ob-gyns received over 15 percent of their overall health care from an ob-gyn compared with 43 percent of total health care received by elderly women who saw family physicians.

  Fink, Baldwin, Lawson, et al., J Fam Pract 50(2):153-8, 2001 (contract 290-93-0136).

• Nonprofit centers rate better than for-profits in serving disadvantaged women.

  Using data on 108 for-profit and 296 nonprofit women's health centers, investigators examined the association between center ownership and community benefits and concluded that nonprofit centers do a better job of serving disadvantaged women than for-profit centers. Nonprofit centers serve larger proportions of uninsured women and rural women, offer reduced rates to more clients based on financial need, offer a broader range of primary care services, and provide clinicians with more frequent training opportunities.

  Khoury, Weisman, and Jarjoura, Med Care Res Rev 58(1):76-99, 2001 (AHRQ grant HS09328).

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