What kinds of health problems affect men and women in Manitoba? Does being male or female make a difference in the health care you receive? These are just some of the questions looked at by a new study from the Manitoba Centre for Health Policy (MCHP) at the University of Manitoba.
The answers are varied and extensive. Seventy-four indicators were used to compare the sexes. They included things like: life expectancy, prevalence of various illnesses, use of health care services, and quality of care. Most of the indicators showed that males and females are different, reinforcing the importance of considering the needs of males and females separately in creating health plans and programs.
Most of the major diseases—like high blood pressure, arthritis, heart disease, stroke, and diabetes—affect both males and females, but to differing degrees, and at different ages. A higher proportion of females had hypertension (25.9 per cent vs. 24.0 per cent), arthritis (22.3 per cent vs. 19.2 per cent), and hip fractures (2.7 vs. 2.2 per 1,000 residents/year). More males had heart disease (7 per cent vs. 4 per cent), heart attacks (7.2 vs. 3.2 per 1,000 residents aged 40+ per year), strokes (4.1 vs. 3.0 per 1,000 residents/year), and diabetes (6.8 per cent vs. 6.3 per cent). Males and females had similar levels of respiratory disease (11.3 per cent vs. 11.9 per cent). The top causes of death were the same for males and females: circulatory disease, cancer, and respiratory illness.
Females saw physicians on average 5.8 times per year, versus 4.5 for males. Once visits for pregnancy, childbirth and other reproductive health issues were removed, the sex difference was reduced (5.1 and 4.3 visits per year, respectively). The story is different for hospital use. There were 155 hospitalizations per 1,000 females, versus 116 for males. But once hospitalizations for reproductive issues are removed, the female rate is actually lower than that for males (101 vs. 110).
The study also examined cardiac care, where previous research has suggested that men are treated more aggressively than women. So this study looked at the situation in Manitoba. After a heart attack, did more males than females get diagnostic and surgical procedures? “Initially it looked like there were higher rates for men than women,” says lead author Randy Fransoo. “However, men have heart attacks at younger ages than women, and younger patients are more likely to receive invasive procedures. So it’s not that males get more procedures, it’s that younger patients get more. At every age, female heart attack patients are just as likely as males to receive interventions, like angiography and bypass surgery.”
However, females were less likely than males to be receiving recommended beta-blockers following their heart attacks (73 per cent vs. 79 per cent).
Does the health care system respond to need? People living in lower income areas have higher rates of illness. It was therefore reassuring to find they also had higher rates of physician visits and more hospitalizations. So the system works, in that it delivers more care to those who need it most.
This report is the third study by The Need to Know Team, a group funded through the Canadian Institutes of Health Research (CIHR) and directed by Dr. Patricia Martens at the University of Manitoba. The Team is made up of high-level planners from each regional health authority, plus Manitoba Health and MCHP researchers. They realized the importance of having separate results for males and females.
Fransoo says, “We hope this research will assist health planners in tailoring programs and services to meet the needs of all their residents—both male and female.”
For more information, contact Randy Fransoo at 204-789-3543.
For a copy of the report, contact Janine Harasymchuk at 204-789-3669.
The report is available online at: http://www.umanitoba.ca/centres/mchp/reports.htm
Below is contact information for the RHAs’ designated spokespersons, and study highlights:
Assiniboine Regional Health Authority
Manager, Planning &Evaluation
Brandon Regional Health Authority
Executive Director, Planning & Evaluation
Burntwood Regional Health Authority
RHA Central Manitoba Inc.
Dr. Shelly Buchan
Medical Officer of Health
Churchill Regional Health Authority
Interlake Regional Health Authority
Nor-Man Regional Health Authority
Director of Planning
204-687-1300 Cell: 204-623-0516
North Eastman Regional Health Authority
204-753-2012, Extension 224
Parkland Regional Health Authority
South Eastman Regional Health Authority
Quality/Risk Management & Planning Coordinator
Health Status & Mortality
· Females live longer than males: 81.3 years vs. 75.8 years for males.
· Top five causes of death the same for males and females:
1. Circulatory diseases (e.g. heart and vascular diseases)
3. Respiratory diseases (e.g. asthma, Chronic Obstructive Pulmonary Disorder)
4. Injury & poisoning
5. Endocrine/metabolic disorders (e.g. diabetes)
Illness and Disease
· Hypertension (high blood pressure; age 25+): 25.9% for females and 24.0% for males.
· Arthritis (age 19+): 22.3% for females and 19.2% for males.
· Respiratory diseases: 11.9% for females and 11.3% for males.
· Diabetes (age 20-79): 6.3% for males and 6.8% for males.
· Ischemic Heart Disease (age 19+): 4.0% for females and 7.0% for males.
· Heart attacks (Acute Myocardial Infarction; age 40+): 7.2 per year per 1,000 males, vs. 3.1 for females.
· Strokes (age 40+): 4.1 per year per 1,000 males, vs. 3.0 for females
· Hip fractures: 2.7 per year per 1,000 females vs. 2.2 for males.
· Females had higher physician visit rates: 5.8 per year vs. 4.5 for males.
§ This difference was reduced once visits for pregnancy and reproductive health issues were removed (to 5.1 vs. 4.3)
· The reasons for physician visits were similar for males and females.
· Females had higher rates of hospitalization than males (162.0 vs. 126.6 per 1,000 residents per year).
§ The difference was eliminated once hospital use for childbirth and reproductive health issues were removed
(100.6 for females vs. 109.6 for males, per 1,000 residents).
· The reasons for hospitalization were similar for males and females.
Surgery & Diagnostic Testing
· Total hip replacements: 1.7 per 1,000 females age 40+ vs. 1.6 for males.
· Total knee replacements: 2.7 per 1,000 females age 40+ vs. 2.1 for males.
· Cataract surgery: 22.2 per 1,000 females age 50+ vs. 20.7 for males.
· CT scan rates were higher for males than females; Urban residents of lower income areas had higher rates.
· MRI scans showed no sex difference; Urban and rural residents of lower income areas had lower rates.
· Residents in Winnipeg or near Winnipeg had higher rates of MRI scans than rural residents further away from Winnipeg.
Prescription Drug Use
Rates for females were higher than males:
· One or more prescriptions dispensed: 69.8% (females) vs. 61.1% (males)
· Number of different drugs dispensed: 4.0 (females) vs. 3.6 (males)
· Antibiotic use: 36.8% (females) vs. 30.7% (males).
· Antidepressant use: 8.6% (females) vs. 4.5% (males).
· No sex differences in childhood or adult immunizations
· Childhood immunization rates stable: One-year olds 82.7%; two-year olds 70.2%; seven-year olds 74.2%.
· Adult immunization rates are increasing: Adult influenza: 67.5% of seniors aged 65+ had a flu shot in 2003/04.
· Adult pneumococcal immunizations: 59.3% of seniors aged 65+ had the shot between 2000/01 and 2003/04.
Home Care & Personal Care Homes (Nursing Homes)
· No sex differences in rate of home care cases, but females used more days (216 vs. 190 days per year)
· Rates of PCH use were higher for females than males aged 75+ (146.3 per 1,000 females vs. 112.5 for males).
· Acuity of PCH admissions increased from previous reports. Level 3 and 4 admissions increased from 50.1% in 1999/2000-2000/01 to 53.9%. Level One or Two admissions decreased from 50% to 47%.
· Cardiac procedure rates were higher for males, consistent with their higher rates of heart disease and heart attacks.
· Age-specific rates of cardiac catheterization after heart attack were the same for males and females.
Quality of Care
· Females had better antidepressant follow-up, asthma care, and eye exams for diabetics.
· Males had better benzodiazepine use, and prescriptions for beta-blockers within four months of heart attacks.