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J Asthma. 2018 Aug;55(8):817-825. doi: 10.1080/02770903.2017.1373805. Epub 2017 Oct 16.

Sex differences in outcomes after discharge from Alberta emergency departments for asthma: A large population-based study.

Author information

1
a Department of Pediatrics , University of Alberta, Edmonton Clinic Health Academy (ECHA) , Edmonton , Alberta , Canada.
2
b Women & Children's Health Research Institute, Edmonton Clinic Health Academy (ECHA) , Edmonton , Alberta , Canada.
3
c Department of Obstetrics & Gynecology , University of Alberta, Lois Hole Hospital For Women, Robbins Pavilion Royal Alexandra Hospital , Edmonton , Alberta , Canada.
4
d R.A. Malatest & Associates Ltd. , Edmonton , Alberta , Canada.
5
e Departments of Medicine and Physiology and Pharmacology , University of Calgary , Calgary , Alberta , Canada.
6
f Department of Family Medicine , University of Alberta, University Terrace, University of Alberta , Edmonton , Alberta , Canada.
7
g Department of Emergency Medicine , University of Alberta, University of Alberta Hospital , Edmonton , Alberta Canada.
8
h Alberta Health Services , Edmonton , Alberta , Canada.
9
i School of Public Health , University of Alberta, Edmonton Clinic Health Academy (ECHA) , Edmonton , Alberta , Canada.

Abstract

OBJECTIVE:

Asthma exacerbations frequently result in emergency department (ED) visits. While sex differences have been identified in some asthma studies, there is a paucity of literature on sex differences in the ED setting, especially population-based ones. This study examines sex differences in important outcomes of patients discharged from EDs for acute asthma in Alberta, Canada.

METHODS:

Alberta residents aged from 2 to 55 years discharged from EDs with a primary diagnosis of asthma during 1999-2011 were identified from administrative databases from a single-payer health care system for the entire geographic region of Alberta. Multivariable Cox regression models analyzed time to first follow-up physician or specialist visit, and logistic regression models analyzed the binary outcome of ED return within 30 days for asthma.

RESULTS:

There were 115,853 discharged patients analyzed (40.4% and 59.1% female in pediatric and adult groups, respectively). Approximately 26% of patients revisited the ED during 1999-2011 and 5.1% did so within 30 days. Women had higher odds of a 30-day ED return after ED discharge than men (unadjusted odds ratio [uOR] = 1.26; 95% confidence interval [CI] 1.17-1.36). Time to first non-ED physician follow-up was shorter for girls (unadjusted hazard ratio [uHR] = 1.05; 95%CI 1.03-1.07) and women (uHR = 1.62; 95%CI 1.59-1.64) than for boys and men, respectively. Significant interactions between sex and age, socio-economic status, area of residence, and comorbidities were identified and changed the effect of sex on outcomes.

CONCLUSIONS:

In conclusion, women return to EDs within 30 days of discharge for acute asthma more often than men. Time to first non-ED physician follow-up for children and adults differed by sex. Multiple factors likely contribute to these differences; however, identifying these differences is critical to understand the influence of sex on health behaviors and outcomes.

KEYWORDS:

Administrative databases; asthma; epidemiology; sex differences

PMID:
28872981
DOI:
10.1080/02770903.2017.1373805
[Indexed for MEDLINE]

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