Gender & Chronic Disease: Assessing Disparities Among the Leading Causes of Death in Texas, 2011

BACKGROUND: American women live longer than men. They also report being in worse health and use more health services than men. The paradox of living longer, but being less healthy has been explained by differences in type and severity of chronic diseases experienced. But recent trends show women achieving smaller gains in life expectancy, suggesting they might now be experiencing diseases as severe and fatal as men. To improve our understanding of gender disparities in chronic disease, we examined differences between women and men in prevalence, hospitalization, and mortality for diseases among the leading causes of death in Texas in 2011.

METHODS: We calculated point and interval estimates (α=0.05) of the relative odds of having each disease and relative incidence of hospitalization and death due to each disease between women and men using three datasets for 2011. We used data, collected from responses to survey questions about having ever been diagnosed with hypertension, heart disease (HD), asthma, chronic obstructive pulmonary disease (COPD), and diabetes, from Texas Behavioral Risk Factor Surveillance System to estimate unadjusted odds ratios (OR) using logistic regression in SAS 9.3. We used hospital data from Texas Hospital Inpatient Discharge Data File and Texas mortality data to estimate unadjusted incidence rate ratios (IRR) using “epitab” in STATA/MP 13.0 among cases of hypertension, HD, asthma, COPD, and diabetes identified in hospital records with APR-DRG: 199, 190 or 198, 141, 140, and 420, respectively, and mortality records with ICD-10 codes: I10-I15, I20-I25 or I70, J45, J41-J44, and E10-14, respectively.

RESULTS: Compared to men, women were more likely to have asthma and less likely to have HD (OR: 2.0 and 0.7, respectively). Women were more likely to be hospitalized for hypertension, asthma, COPD, and diabetes than men (IRR: 2.0, 1.2, 1.6, and 1.1, respectively). Women were more likely to die from hypertension, asthma, and COPD, but less likely to die from HD than men (IRR: 1.2, 1.7, 1.1, and 0.8, respectively).

CONCLUSIONS: The observed patterns in prevalence, hospitalization, and mortality suggest women in Texas experience more severe and fatal forms of some chronic diseases than men. For hypertension, COPD, and diabetes—diseases equally common among women and men—women experience greater risk of being hospitalized and, in the case of hypertension and COPD, greater risk of death. This suggests women experience these diseases differently than men, highlighting the need to improve disease detection and management among women to minimize disparities in severity and fatality.