Sex differences in health problems, diagnostic testing, and referral in primary care.

BACKGROUND

The aim of the study was to investigate sex differences in health problems and in the use of referrals for additional diagnostic procedures, specialists, and paramedical care in the primary care setting.

METHODS

Data stored from 1988 to 1992 by the continuous morbidity registration project of the department of general practice at Nijmegen University were used. The study population consisted of about 60,000 general practice male and female patients of all ages. Recorded health problems, diagnostic investigations, and referrals to specialists were assessed and analyzed. Health problems were categorized into diagnostic rubrics according to the International Classification of Health Problems in Primary Care (ICHPCC-2).

RESULTS

Women presented with more health problems (2286 vs 1598 per 1000 patients per year) and made greater use of secondary medical care (603 vs 376 referred diagnoses per 1000 patients per year) than men, especially in the age group of 25 to 44 years. The category of screening and health education accounted for more than 30% of the sex difference with reference to the diagnostic rubrics overall. When this category was combined with obstetrical diagnoses (9.4%) and diseases of the genitourinary system (18.1%), 60% of the sex difference between men and women was accounted for. Over 60% of the higher overall use of secondary medical care by women was in the prevention and health education category. Mental disorders did not play a major role in the greater overall use of medical care by women.

CONCLUSIONS

Screening tests and health education play a major role in the greater number of health problems presented by women in primary care and in the greater use of additional diagnostic procedures.