Pregnancy, Birth Outcomes, and Family Planning (continued)
- Outpatient support for new mothers
can reinforce breastfeeding after early
postpartum discharge.
According to this study, new mothers
who had normal vaginal deliveries and
remained in the hospital 24 hours or
less were no more likely to discontinue
breastfeeding than other mothers if they
received outpatient breastfeeding
support and one or more home visits
from a nurse specialist. The researchers
studied medical record data from a large
HMO in eastern Massachusetts on
more than 20,000 mother-infant pairs
with normal vaginal deliveries between
October 1990 and March 1998.
Madden, Soumerai,
Lieu, et al., Pediatrics 111(3):519-24,
2003 (AHRQ grant T32 HS00086).
- First trimester ultrasound is a cost-effective
means to identify fetuses with a
high risk of Down syndrome.
According to this study, first trimester
ultrasound screening for nuchal
translucency (swelling at the back of the
neck) either alone or in combination
with maternal serum markers, can
identify more Down syndrome fetuses
and is more cost effective than the
currently used second trimester
screening.
Caughey, Kuppermann,
Norton, and Washington, Am J Obstet
Gynecol 187:1239-45, 2002 (AHRQ
grant T32 HS00086).
- New cost-effective test detects maternal
GBS infection during labor.
Researchers examined the health
benefits, costs, and savings associated
with three strategies for identifying and
treating a hypothetical group of
pregnant women at risk of passing GBS
infection on to their infants. The
analysis showed that using the rapid and
accurate polymerase chain reaction test
to detect maternal GBS infection during
labor is more cost effective than two
current screening strategies (maternal
rectovaginal culture at 35 to 37 weeks of
pregnancy and screening for risk factors
at the time of labor).
Haberland, Benitz,
Sanders, et al., Pediatrics 110(3):471-80, 2002 (AHRQ grant T32 HS00028).
- AHRQ published a report on
managing prolonged pregnancy.
Researchers at Duke University
conducted a systematic review of the
relevant literature on the management of
prolonged pregnancy. The report
provides health plans, providers,
purchasers, and the health care system
with comprehensive, science-based
information.
The full evidence report,
Management of Prolonged Pregnancy,
Evidence Report/Technology Assessment
No. 53 (AHRQ Publication No. 01-E018) and summary (AHRQ
Publication No. 01-E012), are available
from AHRQ (contract 290-97-0014).*
- Study urges discontinuation of low
birthweight index.
This study demonstrates that there is a
bias in the Adequacy of Prenatal Care
Utilization (APNCU) index. The index
was used to study 54 million births and
demonstrated increasing trends toward
the use of more prenatal resources
accompanied by worsening trends in
birth outcomes. The authors call for
further study of the association between
low birthweight and prenatal care use.
Koroukian and Rimm, J Clin Epidemiol
55:296-305, 2002 (AHRQ grant T32
HS00059).
- Preeclampsia risk increases with assisted
conception.
This study examined 525 multiple
gestations to compare the risk of
preeclampsia among women who
conceived as a result of assisted
conception and women who conceived
spontaneously. The former group
experienced nearly three times the
relative risk of mild preeclampsia and
nearly five times the risk of severe
preeclampsia compared with women
who conceived spontaneously. After
adjusting for age and number of
pregnancies, women in the former group
were twice as likely to develop
preeclampsia.
Lynch, McDuffie,
Murphy, et al., Obstet Gynecol 99(3):445-51, 2002 (AHRQ HS10700).
- Preserving women's health is the best
prenatal care target.
Participants at a 1997 conference on the
effects of prenatal care concluded that
treating bacterial vaginosis with
antibiotics during pregnancy, reducing
maternal tobacco use, supplementing
deficient maternal iron stores, and
reducing maternal stress offer some
promise in reducing premature births.
However, providing routine prenatal
care, enhanced nutrition, drugs to
inhibit labor, and home uterine
monitoring to identify early labor have
not been shown to reduce the incidence
of low birthweight infants.
McCormick and Siegel, Ambulatory Pediatr 1(6):321-5, 2001 (AHRQ grant HS09528).
- Many with unplanned pregnancies did
not use contraception.
In a study of 279 women (most of
whom were unmarried and black)
enrolled in a Medicaid managed care
health plan, 78 percent said that their
most recent or current pregnancy had
been unintended. Of these women, more
than 57 percent said they had not used
any birth control in the month before
conception, 5 percent had used birth
control of high effectiveness, and 19
percent had used birth control of
medium effectiveness.
Petersen, Gazmararian, Clark, et al., Women's
Health Issues 11(5):427-35, 2001
(AHRQ grant T32 HS00032).
- Black women living in the Northeast
have the highest rates of abruptio
placentae.
Researchers derived age-adjusted rates of
abruptio placentae (premature separation
of the placenta) for combinations of
regions of birth and regions of residence
of all live singleton births among black
women in the United States during
1995-1996. The region and rates among
women who had not migrated from the
South included the following: Northeast
(8.3 per 1,000), Midwest (6.3 per
1,000), South (6.0 per 1,000), and
West (4.9 per 1,000).
Faiz, Demissie,
Ananth, et al., Ethn Health 6(3):247-53, 2001 (AHRQ grant HS09788).
- First-time moms with unassisted
deliveries fare best.
Data from a 7-week postpartum survey
of women giving birth for the first time
to a single infant were analyzed. Results
show that women who were assisted
with vaginal deliveries reported
substantially worse sexual, bowel, and
urinary functioning than women with
spontaneous vaginal deliveries.
Lydon-Rochelle, Holt, and Martin, Paediatr
Perinat Epidemiol 15:232-40, 2001
(AHRQ grant T32 HS00034).
- Chronic hypertension associated with
an 11-fold increase in risk of
preeclampsia during pregnancy.
The researchers used hospital discharge
records for 1988-1996 involving 38,402
black and 144,285 white pregnant
women who gave birth in the hospital.
Irrespective of race, the risk of
preeclampsia was greater among
younger women (aged 15 to 19) than
older women (aged 20-39) and among
single women compared with married
women. Diabetes and urinary tract
infection increased the risk of
preeclampsia. Both black and white
women with chronic hypertension had
an 11-fold higher risk of developing
preeclampsia during pregnancy.
Samadi, Mayberry, and Reed, Ethnicity Dis
11:192-200, 2001 (AHRQ grant
HS07400).
- Maternal fever during labor is strongly
associated with infection-related
neonatal and infant death.
Maternal fever during labor usually
signals inflammation of the fetal
membranes due to infection. In this
study of birth records for more than 11
million single live births between 1995
and 1997, intrapartum fever tripled the
risk of early neonatal death and doubled
the risk of infant death for term infants.
It was associated with meconium
aspiration syndrome, hyaline membrane
disease, neonatal seizures, and newborn
need for assisted ventilation among
both term and preterm infants.
Petrova, Demissie, Rhoads, et al., Obstet Gynecol
98:20-7, 2001 (AHRQ grant
HS07400).
- AHRQ evidence report presents a
systematic review of the evidence on
vaginal birth after cesarean.
In this report, researchers at AHRQ's
Evidence-based Practice Center at
Oregon Health & Science University
discuss the results of their systematic
review of the scientific literature on the
risks and benefits of vaginal birth after
cesarean (VBAC) and repeat cesarean. Covered
topics include frequency of VBAC;
harms, such as maternal death,
infection, transfusion, and
hysterectomy; uterine rupture; quality
of life after delivery; patient satisfaction;
patient decisionmaking; and nonclinical
factors affecting delivery options.
Copies of Vaginal Birth After Cesarean, Evidence
Report/Technology Assessment No. 71
(AHRQ Publication No. 03-E018, full
report) and summary (AHRQ
Publication No. 03-E017) are available
from AHRQ* (contract 290-97-0018).
- Risk of uterine rupture during labor is
higher for women with a prior
cesarean delivery.
Researchers analyzed the records of
more than 20,000 women who had
their first child delivered by c-section
and delivered a second child either by
cesarean or following labor. Results
show that 91 women who underwent a
trial of labor followed by vaginal
delivery had a uterine rupture during
the second birth. When compared with
women who had repeat c-sections
without labor, uterine rupture was 15
times more likely with prostaglandin
induction of labor and 5 times more
likely when labor was induced without
prostaglandin.
Lydon-Rochelle, Holt,
Easterling, et al., N Engl J Med
345(1):3-8, 2001 (AHRQ grant T32
HS00034).
- Expanded Medicaid programs
decreased the rate of repeat cesareans
during the 1990s.
As more Ohio women became enrolled
in Medicaid managed care versus fee-for-service programs from 1992 to
1997, the overall rate of repeat c-sections
declined, say researchers at
Case Western Reserve University. Based
on an analysis of Ohio birth records
and Medicaid files, study findings also
show that the rate of first-time c-sections
remained about the same for both groups.
Koroukian, Bush, Rimm, J
Managed Care 7:134-42, 2001
(AHRQ grant T32 HS00059).
- Pregnancy-related maternal deaths are
more common for cesarean than for
vaginal birth.
University of Washington researchers
explored the association between
method of delivery and maternal death
and found that women who had c-sections
were four times as likely to die
a pregnancy-related death as women
who had vaginal deliveries. However,
the researchers note that cesarean
delivery may be a marker for serious
preexisting maternal problems and not
necessarily a risk factor for death.
Lydon-Rochelle, Holt, Easterling, et al.,
Obstet Gynecol 97(2):169-74, 2001
(AHRQ grant T32 HS00034).
- Augmented prenatal care does not
reduce low birthweight in poor black
women.
Researchers at the University of
Alabama at Birmingham assigned 318
Medicaid-eligible pregnant black
women to augmented prenatal care and
301 similar women to usual care.
Augmented care included education-oriented
peer groups, extra
appointments, extended time with
clinicians, other supports, and risk-reduction
programs. Augmented care
improved knowledge about pregnancy
risk, social support, care satisfaction,
and a sense of control; however, it did
not reduce the likelihood of low
birthweight.
Klerman, Ramey,
Goldenberg, et al., Am J Public Health
91:105-11, 2001 (Low Birthweight
PORT contract 290-92-0055).
Return to Contents
Women and Medications
AHRQ has a growing research program
focused on medication use by women,
including the use of antibiotics,
contraceptives, drugs to prevent or treat
osteoporosis, and hormone replacement
therapy to ease the symptoms of
menopause. AHRQ also supports
studies focused on medication safety,
the cost of medications, and other related topics. Examples of recent
findings from these studies include the
following.
- Estrogen therapy with progestin is
often discontinued in women who
have diabetes or cardiovascular disease.
For this study, researchers examined
data from five HMOs on hormone use
among nearly 170,000 women aged 40
to 80. They found a greater decline in
use of estrogen plus progestin therapy
(HRT) by women with diabetes or
cardiovascular disease than other
women following release of findings in
2002 from the Women's Health
Initiative study. According to the WHI
study findings, combination estrogen-progestin
therapy increased women's
risk for breast cancer, stroke, and
pulmonary embolism. Discontinuation
rates increased nearly seven-fold among
women with diabetes and nearly six-fold
among women with cardiovascular
disease. Newton, Buist, Miglioretti, et
al., J Gen Intern Med 20:350-6, 2005
(AHRQ grant HS11843).
- Women respond differently to
medications than men and should be
proactive about their medication use.
Women take more medications than
men. They also respond differently to
medications and are more likely than
men to suffer medication-related
problems. Thus, women should be
proactive about their medication use.
They should take responsibility for their
own health and ask clinicians questions
about diagnosis, treatment, and
medication use. It is important for
women to make sure they understand
the need for each medication they are
prescribed, and they should be sure to
take their medications according to
their doctor's instructions. The author
provides a number of other caveats for
women related to medication use.
Correa-de-Araujo, J Women's Health
14(1):12-5, 2005; see also pages 16-8
in the same journal. (Reprints, AHRQ
Publication Nos. 05-R020 and 05-R021) (Intramural).
- Task Force recommends against
routine use of estrogen in
postmenopausal women who have
undergone hysterectomy.
The U.S. Preventive Services Task Force
has issued a recommendation against
the routine use of estrogen to prevent
chronic conditions—such as heart
disease, stroke, and osteoporosis—in
postmenopausal women who have
undergone a hysterectomy. They noted
that although estrogen can have positive
effects such as reducing the risk for
fractures, hormone therapy should not
be used routinely because it appears to
increase women's risk for potentially
life-threatening clots that block blood
vessels, as well as stroke, dementia, and
mild cognitive impairment. Materials
for clinicians and consumers are
available at http://www.ahrq.gov/clinic/prevenix.htm (AHRQ contract
290-97-0011).
- Use of hormone therapy plummeted
after release of findings from the
Women's Health Initiative trial.
The researchers used automated
pharmacy data to identify all oral and
transdermal (patches) HRT
prescriptions dispensed between
September 1, 1999, and June 21, 2002
(baseline), and December 31, 2002
(followup), to 169,586 women aged 40
to 80 enrolled in five HMOs. At
followup (5 months after trial results
were published), 46 percent fewer
women were taking combination
estrogen-progestin therapy, and 28
percent fewer women were taking
estrogen alone. There also was an
immediate and dramatic decrease in the
number of women initiating HRT use.
Buist, Newton, Miglioretti, et al., Obstet
Gynecol 104:1042-50, 2004 (AHRQ
grant HS11843). See also Hillman,
Zuckerman, and Lee, J Women's Health
13(9):986-92, 2004 (AHRQ grant
HS11673); and Majumdar, Almasi, and
Stafford, JAMA 292(16):1983-8,
2004 (AHRQ grant HS13405).
- Older women used more medications
and had higher drug expenses than
same-age men from 1999 to 2001.
Women aged 65 and older had
expenditures for prescription
medications that were 17 percent higher
than men of the same age, according to
this analysis of MEPS data for 1999,
2000, and 2001. Overall, older women
spent an average of $1,178 per year,
compared with $1,009 spent by older
men. Also, women were somewhat
more likely than men (92 percent vs. 88
percent) to use prescription drugs, with
women purchasing almost 20 percent
more prescription drugs on average than
men. Correa-de-Araujo, Miller,
Banthin, and Trinh, J Women's Health
14(1):73-81, 2005 (Reprints, AHRQ
Publication No. 05-R019)
(Intramural).*
- Pregnant women are sometimes given
drugs that may be unsafe to take
during pregnancy.
Researchers reviewed data from eight
health maintenance organizations in
diverse geographic areas involving more
than 150,000 women who delivered an
infant in a hospital between January 1,
1996, and December 31, 2000. They
found that 64 percent of women were
dispensed a medication other than a
vitamin or mineral supplement within
the 270 days before delivery. Nearly 40
percent of these women received a drug
for which human safety has not been
established. About 5 percent of the
women received a drug for which the
evidence indicates definite fetal risk, and
the risk of using the drugs clearly
outweighs any possible benefit.
Andrade, Gurwitz, Davis, et al., Am J
Obstet Gynecol 191:398-407, 2004
(AHRQ grant HS10391).
- Among privately insured adults 65
and older, women spend substantially
more than men on prescription
medicines.
According to this study, women have
higher drug expenditures than men due
to higher rates of use rather than high
prices paid for drugs. Because women
constitute the majority of the older
adult population and are more likely
than men to be chronically ill, they use
more health services, including
medications. The researchers examined
1999-2001 data on 1,346 women and
1,312 men with 61,999 prescription
drug purchases during the study period.
Total prescription drug expenditures
were $6.93 million for women and
$5.77 million for men. This difference
is likely to be much larger in the full
population of older adults, where
women outnumber men by a much
larger margin than in this study.
Correa-de-Araujo, Miller,
Banthin, and Trinh, J Women Health
14(1):73-80, 2005. Reprints (AHRQ
Publication No. 05-R019) are available
from AHRQ (Intramural).*
- Journal supplement focuses on use of
medications by women.
In April 2004, AHRQ convened a 2-day expert panel meeting of 35 experts
who focused on issues related to
improving the use and safety of
medications by women. The January
2005 issue of the Journal of Women's
Health presents papers from the
meeting, including three papers by
AHRQ's Senior Advisor on Women's
Health. One paper on disparities and
costs is described above. The other two
are an introduction to the supplement
and a short piece on using medications
safely.
Correa-de-Araujo, J Women
Health 14(1):12-5 and 16-8, 2004.
Reprints (AHRQ Publication Nos. 05-R020 and 05-R021) are available from
AHRQ (Intramural).*
- Using oral erythromycin with certain
other drugs increases risk of sudden
cardiac death.
Patients who took the antibiotic
erythromycin with certain other
commonly prescribed medications had a
five times greater risk of sudden death
from cardiac causes, including torsades
de pointes, than patients who did not
take the drugs at the same time. These
drugs included certain calcium channel-blockers,
certain anti-fungal drugs, and
some antidepressants. Research has
shown that women are at increased risk
for prolongation of the QT interval,
which may lead to torsades de pointes, a
potentially fatal ventricular arrhythmia.
Ray, Murray, Meredith, et al., New Engl
J Med 351(11):1089-96, 2004
(AHRQ grant HS10384); and Al-Khatib, LaPointe, Kramer, and Califf, J
Am Med Assoc 289(16):2120-7,
2003 (AHRQ grant HS10548).
- Quality-of-life benefits of short-term
HRT may outweigh the risk for some
women.
The researchers examined the trade-off
between short-term relief of menopausal
symptom and risks of harm from
HRT—heart disease, stroke, pulmonary
embolism, and breast cancer—to
determine if some women might benefit
from a short course of HRT (up to 2
years). They found that women with
the most severe menopausal symptoms
benefitted the most, but even those with
mild menopausal symptoms gained in
quality of life scores. They also found
that individual risk for harms had little
effect, reflecting the small relative risk of
HRT on these outcomes given the short
duration of HRT.
Col, Weber, Stiggelbout, et al., Arch Intern Med
164:1634-40, 2004 (AHRQ grant
HS13329).
- Clinicians and patients responded
quickly to evidence of harms associated
with hormone therapy.
Results from the Women's Health
Initiative were published in July 2002.
They showed that oral estrogen
combined with progestin increased the
risk of cardiovascular disease and breast
cancer in postmenopausal women. Over
the next year, hormone therapy
prescriptions declined substantially from
prepublication levels.
Hersh, Stefanick,
and Stafford, JAMA 291(1):47-53,
2004 (AHRQ grant HS13405).
- Findings from the Nurses' Health
Study seem to contradict the Women's
Health Initiative findings.
Unlike the randomized Women's Health
Initiative that showed no benefit of
menopausal HRT on coronary heart
disease, observational studies like the
Nurses' Health Study found it to be
protective. These differences have been
attributed to the fact that women who
choose to use HRT tend to be healthier
than those who do not. However,
reporting biases of those who believe in
HRT may have affected the
interpretation of heart disease outcomes
in observational studies.
Col and Pauker, Ann Intern Med 139:923-9,
2003 (AHRQ grant HS13329).
- HRT may increase the risk of heart
disease.
Researchers conducted two systematic
reviews of the evidence on
postmenopausal use of HRT. The
reviews were prepared for the U.S.
Preventive Services Task Force. They
show that harms could exceed benefits
for women taking HRT for 5 years or
longer to prevent chronic conditions.
Harms include an increased risk of
blood clots and stroke, an increase in
breast cancer with 5 or more years of
use, and a probable increase in
gallbladder disease.
Humphrey, Chan,
and Sox, Ann Intern Med 137(4):273-84, 2002; Nelson, Humphrey, Nygren,
et al., JAMA 288(7):872-81, 2002
(contract 290-97-0018).
- Women using estrogen are at risk for
thromboembolism.
These authors identified three
randomized controlled trials, eight case-control
studies, and one cohort study to
assess the risk of venous
thromboembolism in women using
estrogen replacement therapy.
Postmenopausal estrogen replacement is
associated with an increased risk for
venous thromboembolism.
Miller,
Chan, and Nelson, Ann Intern Med
136(9):680-90, 2002 (contract 290-97-0011).
- Estrogen therapy does not improve
cognitive performance.
Researchers analyzed data on a
community-based sample of 885
postmenopausal women aged 60 to 89
who had undergone a hysterectomy.
Among those not using estrogen, there
were no significant differences on mean
cognitive function scores. Among those
using estrogen, women with a
hysterectomy and bilateral
oophorectomy performed less well on
two tests of cognitive function.
Kritz-Silverstein and Barrett-Connor, J Am
Geriatr Soc 50:55-61, 2002 (AHRQ
HS06726).
Return to Contents
Osteoporosis
In the United States today, 10 million
people have osteoporosis, and another 18
million have low bone mass, placing
them at risk for this condition. Women
are four times more likely than men to
develop osteoporosis, and one of every
two women will have an osteoporosis-related
fracture in her lifetime. Although
osteoporosis is the underlying cause of
most fractures in older people, it is silent
and often goes undetected until a
fracture occurs. U.S. health care costs
related to osteoporosis are estimated to
be $10 to $15 billion per year.
- Better medications for osteoporosis
have increased recognition and
treatment of the disease.
More effective and convenient
medications for osteoporosis increased
osteoporosis-related doctor visits four-fold
between 1994 and 2003. The
largest increases coincided with market
approval of two important osteoporosis
drugs—alendronate (September 1995)
and raloxifene (December 1997).
Stafford, Drieling, and Hersh, Arch
Intern Med 164:1525-30, 2004
(AHRQ grant HS13405).
- Few postmenopausal women who have
suffered a fracture receive medication
to prevent further fractures.
This study of postmenopausal women
enrolled in seven HMOs across the
country found that only 24 percent of
those who had suffered an osteoporosis-related
fracture received drug treatment
for osteoporosis within a year following
the fracture. Older women were less
likely than younger women to receive
osteoporosis treatment, even though
aging increases the risk of fracture.
Andrade, Majumdar, Chan, et al., Arch
Intern Med 163:2052-7, 2003
(AHRQ grant HS10391).
- Clinical practice lags behind guidelines
for osteoporosis screening and
treatment.
Researchers examined administrative
data and medical records for nearly
4,000 women (average age 71) enrolled
in an HMO who had been diagnosed
with a new fracture from 1998 to 2001.
Only about 12 percent of the women
had been diagnosed with osteoporosis
prior to the fracture, even though nearly
11 percent had conditions or were taking
medications that would put them at risk
for the condition. Also, 39 percent of the
women were already at increased risk of
falling due to medical problems (e.g.,
dementia) or medication (e.g.,
antidepressants). Physician adherence to
guidelines—which call for bone mineral
density testing to detect bone loss and,
when needed, medication to treat
osteoporosis—did not significantly
improve from 1998 to 2001.
Feldstein, Nichols, Elmer, et al., J
Bone Joint Surg 85(12):2294-302,
2003 (AHRQ grant HS13013).
- Racial disparities found in receipt of
osteoporosis screening and
management.
According to this survey of more than
8,000 women aged 50 or older in
Alabama, postmenopausal black women
are much less likely than their white
counterparts to receive bone mineral
density testing to detect osteoporosis or
to be prescribed medication for
osteoporosis. This finding held even
among those who had a previous
fracture.
Mudano, Casebeer, Patino, et
al., South Med J 96(5):445-51, 2003
(AHRQ grant HS10389).
- The USPSTF updates osteoporosis
screening recommendations.
The U. S. Preventive Servies Task Force
recommends that women 65 and older
receive routine screening for
osteoporosis to reduce the risk of
fracture and spinal abnormalities often
associated with the disease. The
USPSTF also recommends that routine
screening begin at 60 for women
identified as high risk because of their
weight or estrogen use.
Nelson, Helfand, Woolf, and Allan, Ann Intern
Med 137(6):529-41, 2002 (AHRQ
contract 290-97-0011).
Return to Contents
Women and Working Conditions
- Staffing patterns and nurses' working
conditions are associated with patient
safety and medical errors.
Nearly 3 million registered nurses (RNs)
work in the United States, and 95
percent of these nurses are women, as are
most licensed practical nurses and
unlicensed nurse assistants. According to
AHRQ's Senior Advisor on Women's
Health and her colleagues, nurses'
working conditions are often poor and
contribute to recruitment and retention
problems, resulting in a shortage of
qualified nurses and threatening public
safety. Monitoring and improving the
working conditions of nurses would be
likely to improve health care quality by
decreasing the incidence of many
infectious diseases, assisting in retaining
qualified nurses, and encouraging others
to enter the profession.
Stone, Clarke,
Cimiotti, and Correa-de-Araujo, Emerg
Infect Dis 10(11):1984-9, 2004
Reprints (AHRQ Publication No. 05-R006) are available from AHRQ
(Intramural).*
- Nurses play an important role in
patient safety and quality of care.
As caregivers, nurses represent the
frontline surveillance system in many
health care settings, and often, they can
detect potential errors before a patient is
harmed. Extended hours and workload
are key factors in nurses' work
environments. Most nursing staff are
women, and substantial numbers of
them are leaving the field for other
careers. Improving working conditions
for nurses may increase the supply of
nurse workers and reduce adverse patient
outcomes.
Emerg Infect Dis 10(11),
2004; available online at
http://www.cdc.gov/ncidod/EID. Reprints
(AHRQ Publication No. 05-R012) are
available from AHRQ (Intramural).*
Return to Contents
Other Research
- Women differ from men in the effects of
social class on behavioral risk factors.
This study of British civil servants
explored reasons for the differences in
various conditions between men and
women by analyzing their own or their
spouse's socioeconomic position and a set
of risk factors for prevalent chronic
diseases. The researchers found that
social inequality affected women more
than men, and that a nonworking
husband or male partner was associated
with lower levels of social support and
higher negative social support; men with
nonworking wives or partners were not
affected. These findings have
implications for future studies of
male/female differences in health and risk
factors.
Bartley, Martikainen, Shipley,
and Marmot, Soc Sci Med 59:1925-36,
2004 (AHRQ grant HS06516).
- Renal disease may progress faster in
women than in men.
According to this study, renal disease
progression is not slower in women than
in men, and it may even be faster. The
researchers analyzed pooled data from 11
randomized trials evaluating the efficacy
of angiotensin-converting enzyme (ACE)
inhibitors for slowing renal disease
progression. Overall, nearly 17 percent of
patients had a doubling of baseline
serum creatinine, and 9.5 percent
developed end-stage renal disease.
Women had a 32 to 36 percent higher
risk than men of doubling their baseline
serum creatinine.
Jafar, Schmid, Stark, et
al., Nephrol Dial Transplant 18:2047-53, 2003 (AHRQ grants HS13328
and HS10064).
- Women are more likely than men to
experience long-term posttraumatic
stress disorder after major trauma.
Regardless of the type or severity of
traumatic injury, women are more than
twice as likely as men to suffer from
PTSD, according to a study involving
1,048 adult trauma patients triaged at
four trama center hospitals between
1993 and 1996. Patients were evaluated
at discharge and at 6, 12, and 18
months postdischarge.
Holbrook, Hoyt, Stein,
and Sieber, J Trauma 53:882-8, 2002
(AHRQ grant HS07611).
- How posttraumatic stress affects
women's health is unclear.
The literature on PTSD, hostility, and
health was examined to determine
possible mechanisms underlying the
relationship between PTSD and
hostility on health outcomes. Results
show hostility is a risk factor for
hypertension, coronary heart disease,
and heart attack; and PTSD is
associated with increased health
problems including arthritis, bronchitis,
migraines, and gynecological
complaints. However, the mechanisms
responsible are unclear.
Beckham, Calhoun, Glenn, et al., Ann Behav Med
24(3):219-28, 2002 (AHRQ grant T32
HS00079).
- Women suffer more than men before
and after hip replacement surgery.
This study examined differences in
functional status and pain at the time of
total hip arthroplasty (THA) and 1 year
later in a group of 432 male and 688
female Medicare beneficiaries. Results
show that the women were in worse
shape than the men when they elected
THA. After 1 year, women walked
shorter distances and were more likely
than men to report needing help with
walking (30 vs. 21 percent); housework
(29 vs. 23 percent); and grocery
shopping (27 vs. 19 percent).
Holtzman, Saleh, and Kane, Med Care 40(6):461-70, 2002 (AHRQ grant HS09735).
- A low sense of control causes depression
and anxiety.
Researchers analyzed data on
demographics, work characteristics, and
physical and mental health of British
civil servants. Women with low control
at home had more than twice the risk of
depression as women with high control.
Also, women in the lowest employment
grade with low control at home had
significantly higher risk for depression
than men across all grades and women
in higher grades. Women in the lowest
grade had a higher risk for anxiety than
women in higher grades.
Griffin, Fuhrer, Stansfeld, et al., Soc Sci Med 52:783-98,
2002 (AHRQ HS06516).
- Women are more likely than men to be
diagnosed as depressed.
Doctors examined the absence or
presence of a depression diagnosis
among 508 patients seeking care from a
university medical center as well as
sociodemographic characteristics, self-reported
depressive symptoms, and
general health status obtained through
interviews. Women expressed more
symptoms of depression (6.4 vs. 4.3
percent), had a higher mean number of
primary care clinical visits (4.0 vs. 3.1
percent), and were significantly more
likely to be diagnosed as depressed (19
vs. 9 percent) than men.
Bertakis,
Helms, Callahan, et al., J Womens Health
Gender-Based Med 10(7):689-98, 2001
(AHRQ grants HS06167 and
HS08029).
- Women are less likely than white men
to be recommended for kidney
transplants.
A national random survey of 271 U.S.
nephrologists was used to gauge their
criteria for transplant recommendations
for people with end-stage renal disease.
All clinical factors being equal, results
show that white men were almost 2.5
times as likely as white women to be
recommended for kidney transplants.
White women were equally as likely as
black women and Asian men were half
as likely as white men to be
recommended for transplantation.
Thamer, Hwang, Fink, et al.,
Transplantation 71(2):281-8, 2001
(AHRQ grant HS08365).
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Medical Expenditure Panel Survey
In 1996, AHRQ launched the Medical
Expenditure Panel Survey (MEPS), a
nationally representative survey to
collect detailed information on health
status, health care use and expenses, and
health insurance coverage for
individuals and families in the United
States, including nursing home
residents. MEPS is helping the Agency
to address many questions important to
women, including how health insurance
coverage, access to care, use of
preventive care, the growth of managed
care, changes in private health
insurance, and other changes in the
health care system are affecting the
kinds, amounts, and costs of health care
services used by women. For more
information related to MEPS, visit the
AHRQ MEPS Web site at http://www.meps.ahrq.gov/.
Return to Contents
More Information
Select for more information about AHRQ and its research portfolio
and funding opportunities.
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* Items marked with an asterisk are available free from the AHRQ Clearinghouse. To order, contact the Clearinghouse at:
Phone: 1-800-358-9295 (outside of the U.S., phone 410-381-3150)
E-mail: AHRQPubs@ahrq.hhs.gov
Please use the AHRQ publication number when ordering.
Current as of January 2006
AHRQ Publication No. 06-P008
(Replaces AHRQ Publication No. 05-P004)
Internet Citation:
AHRQ Women's Health Highlights: Recent Findings. Program Brief. AHRQ Publication No. 06-P008, January 2006. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/research/womenh1.htm
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