Introduction
Gender Differences in Healthcare-Seeking
for Urinary Incontinence and the Impact of
Socioeconomic Status: A Study of the
Medicare Managed Care Population
†
Prevalence of UI in the community:
„
„
†
Yue Li, PhD, SUNY at Buffalo
Xueya Cai, MA, SUNY at Buffalo
Laurent Glance, MD, University of Rochester
Dana Mukamel, PhD, University of California, Irvine
†
11% - 34% for elderly men
17% - 55% for elderly women
UI is associated with increased risk of morbidities
(pressure sores, UTI, etc.), and has impact on social
and psychological well-being
Effective treatments exist
Supported by a grant from the National Institute on Aging (AG029608-01)
6/3/2007
Introduction (cont’d)
†
†
Introduction (cont’d)
A large percent of incontinent elders do not seek
professional advice or treatment.
†
„
„
„
„
„
„
Misconception that UI is a normal consequence of aging
or childbirth
Lack of knowledge of treatment options and effectiveness
Embarrassment
Fear of needing an operation
Caregiver’s failure to inquire about the problem for
patients at risk of UI
6/3/2007
Well-Studied Gender Differences in
„
Barriers to health care seeking:
„
†
3
6/3/2007
Data
This Study
†
„
„
†
UI care seeking behaviors
Receipt of UI treatment
4
Medicare Health Outcomes Survey (HOS)
„
Gender Differences in
Etiology
Symptoms
Prevalence
Gender Differences in Healthcare Seeking?
Introduction (cont’d)
†
2
„
„
National survey on Medicare managed care participants
Enrolled for at least 6 months
Information about demographics, education, income,
ADLs, SF-36 score, medical conditions
Variation of Gender Differences by
„
„
6/3/2007
Age groups
Socioeconomic status
5
6/3/2007
6
1
Data – UI Questions
Analyses
Q44. Many people experience problems with urinary incontinence, the leakage
of urine. In the last 6 months, have you accidentally leaked urine?
1 = Yes (Go to Q45)
†
„
Q45. How much of a problem, if any, was the urine leakage for you?
1 = A big problem (Go to Q46) 2 = A small problem (Go to Q46)
3 = Not a problem (Go to Q48)
†
„
„
2 = No (Go to Q48)
„
Q47. There are many ways to treat urinary incontinence including bladder
training, exercises, medication and surgery. Have you received these or
any other treatments for your current urine leakage problem?
6/3/2007
7
1 = Yes
Main effect of gender
Interactions of gender with age groups
Interactions of gender with education levels
Interactions of gender with annual household income
levels
6/3/2007
8
2 = No
Results
Results of Multivariate Analyses
Patients with UI Problem
Female
Male
P(n=20,727)
(n=7,997)
Value
Characteristic
Having consulted a doctor, %
UI Magnitude, %
Small Problem
Big Problem
Age Group, %
65 – 69
70 – 74
75 – 79
80 and over
Education Years, %
0 – 12
12 – 16
16 and over
Annual Household Income, %
<$20k
$20 – $80k
6/3/2007
$80k and over
P r e d ic t e d R a t e o f D is c u s s in g U I
P r o b le m
Whether UI patients discussed the problem with a health
provider
Whether patients having had such a discussion received
treatment
Gender difference
„
Q46. Have you talked with your current doctor or other health provider about
your urine leakage problem?
1 = Yes (Go to Q47)
Multivariate logistic regressions of
„
2 = No (Go to Q48)
46.2
55.7
77.0
23.0
83.1
16.9
12.8
27.2
25.5
34.6
11.2
26.8
28.1
33.9
Female Gender
Overall
0.000
0.000
0.000
0.000
27.6
61.9
10.4
28.5
50.8
20.7
63.4
34.8
1.9
44.0
52.0
4.0
0.000
9
0.7
By Age Group
65 – 69
70 – 74
75 – 79
80 and over
0.59
0.62
0.61
0.74
0.000
0.000
0.000
0.000
By Education Years
0 – 12
12 – 16
16 and over
0.66
0.64
0.65
0.000
0.000
0.000
By Annual Household Income
<$20k
$20 – $80k
$80k and over
0.66
0.64
0.50
0.000
0.000
0.000
6/3/2007
Female
0.6
Response 1: Discussing UI Problem
Odds Ratio
P-Value
0.65
0.000
Male
10
Results
0.5
Patients Having Discussed the UI
Problem with a Doctor
0.4
0.3
Female
(9,565)
Male
(4,455)
P-Value
54.8
51.4
0.000
Small Problem
64.6
75.6
Big Problem
35.4
24.4
Characteristic
0.2
0.1
Having Received UI Treatment
after Discussion, %
0
Overall
65-69 70-74 75-79 80+
Age
UI Magnitude, %
0--12 12--16 16+
<20k 20-80k 80k+
Education Years
Household Income
Figure 1. Gender Difference in Predicted Rate of Discussing
Urinary Incontinence (UI) Problem with a Healthcare Practitioner
(P=0.000 for overall gender difference and that in each subgroup)
6/3/2007
11
6/3/2007
0.000
12
2
P r e d i c te d R a te o f R e c e i v i n g U I T r e a tm e n t
0.7
0.6
**
*
**
**
**
*
**
Female
**
Male
0.5
0.4
Summary of Findings
†
0.3
Possible reasons:
„ Women are more knowledgeable and experienced in
personal coping strategies
„ Women tend to “normalize” their urine symptom
„ Men are more concerned about underlying pathologies
0.2
0.1
0
Overall
65-69 70-74 75-79
Age
80+
0--12 12--16 16+
Education Years
<20k 20-80k 80k+
Household Income
Figure 2. Gender Difference in Predicted Rate of Receiving
Treatment for Urinary Incontinence (UI) Problem after Discussion
with a Healthcare Practitioner (*P<0.05, **P<0.01)
6/3/2007
Lower rate of help seeking among elderly women
13
†
Higher rate of receiving UI treatment among elderly
women after consulting a doctor
6/3/2007
14
Discussion
†
Quality-of-care for elderly UI patients
„
†
The overall low rate of UI treatment (54.8% and 51.4%,
respectively) indicates quality deficiencies for patients of
both genders
Socioeconomic bias for women
„
„
6/3/2007
Lower treatment rate of UI associated with lower
education and income
Other studies: reduced access to regular mammograms,
osteoporosis treatment, and Pap smear screening for the
poor
15
3