Baibergenova Akerke, Thabane Lehana, Akhtar-Danesh Noori, Levine Mitchell, Gafni Amiram, Leeb Kira
McMaster University, Faculty of Health Sciences, Department of Clinical Epidemiology and Biostatistics, Centre for Evaluation of Medicines, St Joseph's Healthcare, Hamilton, Ontario, Canada.
Ann Allergy Asthma Immunol. 2006 May;96(5):666-72. doi: 10.1016/S1081-1206(10)61063-0.
Women represent the majority of adult patients hospitalized for asthma. Analyzing the course of emergency department (ED) visits before hospital admission can help understanding of the mechanisms behind the excess of hospitalizations in women.
To investigate sex differences in hospital admission rates in adult patients with asthma visiting EDs in Ontario.
Asthmatic patients 18 to 55 years old who visited Ontario EDs between April 1, 2003, and March 31, 2004, were identified using the Canadian Institute for Health Information's National Ambulatory Care Reporting System. The generalized estimating equations for binary outcome were used to model rates of hospital admission with sex, age, and triage (severity) score as covariates. Analysis was further stratified by the ED volume.
Women represented 62.2% of all ED visits. They were on average older than men, but both groups had similar distributions of triage scores. Female patients accounted for more hospital admissions than male patients (7.4% vs 4.5%). After adjusting for age and triage score, women were more likely to be admitted than men (odds ratio, 1.64; 95% confidence interval, 1.41-1.90). The interaction found between sex and triage level indicates that hospitalized women may have less severe asthma than hospitalized men. Analysis by ED volume did not significantly alter the results.
The higher admission rates in women may be related to sex differences in the subjective perception of dyspnea, management of asthma by ED physician, or inadequate ambulatory care strategies in women and thus merit further investigation.
女性占因哮喘住院的成年患者的大多数。分析入院前急诊科就诊过程有助于理解女性住院人数过多背后的机制。
调查安大略省因哮喘前往急诊科就诊的成年患者住院率的性别差异。
利用加拿大卫生信息研究所的国家门诊护理报告系统，确定2003年4月1日至2004年3月31日期间前往安大略省急诊科就诊的18至55岁哮喘患者。将二元结局的广义估计方程用于以性别、年龄和分诊（严重程度）评分作为协变量对住院率进行建模。分析进一步按急诊科就诊量分层。
女性占所有急诊科就诊人数的62.2%。她们的平均年龄比男性大，但两组的分诊评分分布相似。女性患者的住院人数多于男性患者（7.4%对4.5%）。在调整年龄和分诊评分后，女性比男性更有可能入院（优势比，1.64；9可信区间，1.41-1.90）。性别与分诊水平之间的相互作用表明，住院女性的哮喘严重程度可能低于住院男性。按急诊科就诊量进行的分析并未显著改变结果。
女性较高的住院率可能与呼吸困难主观感受的性别差异、急诊科医生对哮喘的管理或女性门诊护理策略不足有关，因此值得进一步研究。
