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Women's Health Highlights: Recent Findings

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).

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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 benefited 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).

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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 Services 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).

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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).*

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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 trauma 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/.

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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