Women's Health Highlights: Recent Findings (continued)

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Women and Medications

AHRQ has a growing research program focused on medication use by women, including the use of antibiotics, contraceptives, drugs to prevent or treat osteoporosis, and hormone replacement therapy to ease the symptoms of menopause. AHRQ also supports studies focused on medication safety, the cost of medications, and other related topics. Examples of recent findings from these studies include the following.

Women are prescribed more drugs than men during their reproductive years.
According to this study, women in their reproductive years received more prescriptions than men in 48 of 53 drug classes. These included drugs commonly used to treat urinary tract and vaginal infections, migraine headaches, mental health conditions, pain, and gastrointestinal ailments. As they aged, the prescribing patterns changed; men received more drugs than women for angina, heart failure, high blood pressure, elevated cholesterol, and risk of blood clots, even though older women suffer from these conditions at the same rate as men. Anthony, Lee, Bertram, et al., J Women's Health 17(5):735-43, 2008 (AHRQ grant HS17001).
Pregnant women continue to receive a class of high blood pressure medications dangerous to the fetus.
Use of antihypertensive angiotensin-converting enzyme (ACE) inhibitors is contraindicated during the second and third trimesters of pregnancy because they are dangerous to the fetus, yet the number of pregnant women prescribed these medications increased steadily between 1986 and 2003, according to this study. This increase was despite an FDA black box warning against such use issued in 1992. The researchers examined data on 262,179 Medicaid-enrolled pregnant women and found that the use of ACE inhibitors increased 4.5-fold (from 11.2 to 58.9 per 10,000 pregnancies) during the study period. Bowen, Ray, Arbogast, et al., Am J Obstet Gynecol 198:291,e1-291, e5, 2008 (AHRQ grant HS10384).
Use of oral diabetes agents or insulin to treat gestational diabetes appears beneficial, and the likelihood of harm is low.
This review of the evidence focused on the risks and benefits associated with use of an oral diabetes agent compared with all types of insulin for gestational diabetes. Other areas reviewed include any risk factors that might be associated with the development of type 2 diabetes after gestational diabetes; the reliability of diagnostic tests for type 2 diabetes in women with gestational diabetes; and whether there is evidence that elective labor induction, cesarean delivery, or timing of induction is associated with risks and benefits for mother and neonate. Therapeutic Management, Delivery, and Postpartum Risk Assessment and Screening in Gestational Diabetes, Evidence Report/Technology Assessment No. 162 (AHRQ Publication No. 08-E004)* (AHRQ contract 290-02-0018). Available online at http://www.ahrq.gov/clinic/tp/gestdiabtp.htm.
Use of antidepressants during pregnancy carries risks for preterm birth and other problems.
Researchers identified 2,201 women who were prescribed an antidepressant during pregnancy and subsequently delivered an infant within one of five large managed care organizations. They found that full-term infants exposed to selective serotonin reuptake inhibitors (SSRIs) during the third trimester had a higher risk of respiratory distress syndrome, endocrine and metabolic disturbances, low blood sugar levels, temperature regulation disorders, and convulsions. Infants exposed to tricyclic antidepressants (TCAs) during the third trimester had the same elevated risks, except for low blood sugar and convulsions. Neither drug was associated with an increased risk for congenital anomalies. Davis, Rubanowice, McPhillips, et al., Pharmacoepidemiol Drug Saf 16:1086-94, 2007 (AHRQ grant HS10391). See also Cooper, Willy, Pont, and Ray, Am J Obstet Gynecol 196(6):544e1-544e5, 2007 (AHRQ grant HS10384).
FDA Class D and X medications are given to a small percentage of pregnant women.
Class D and X medications should not be given to pregnant women because they can harm the fetus. Category D drugs include progesterone, tetracycyline, aspirin, cortisone, Retin-A, and lithium; category X drugs include oral contraceptives and estrogen, medroxyprogesterone, simvastatin, trazolam, and warfarin. This survey found that prescriptions for D and X drugs accounted for 6.4 percent of private physician visits and 2.9 percent of visits to hospital clinics by pregnant women in 1999 and 2000; in 1 of every 10 private physician visits, a pregnant women received a drug with an unknown pregnancy risk. Lee, Maneno, Smith, et al., Pharmacoepidemiol Drug Saf 15:537-45, 2006 (AHRQ grant HS11673).
Many osteoporosis medications prevent fractures, but none has been shown to be best.
According to this report, not enough scientific evidence exists to establish whether bisphosphonates (the most commonly used osteoporosis drugs) are better at preventing fractures than estrogen, calcitonin, or raloxifene. The report also indicates that many osteoporosis patients stop taking their medications as prescribed. Some stop because they do not have osteoporosis symptoms; others stop because of medication side effects or because dosing is too frequent. Not taking medications as prescribed increases the risk of bone fractures. Comparative Effectiveness of Treatments to Prevent Fractures in Men and Women with Low Bone Density or Osteoporosis, Comparative Effectiveness Review No. 12, 2007; online at http://www.effectivehealthcare.ahrq.gov (AHRQ contract 290-02-0003).
Estrogen therapy with progestin is often discontinued in women who have diabetes or cardiovascular disease.
For this study, researchers examined data from five HMOs on hormone use among nearly 170,000 women aged 40 to 80. They found a greater decline in use of estrogen plus progestin therapy (HRT) by women with diabetes or cardiovascular disease than other women following release of findings in 2002 from the Women's Health Initiative study. According to the WHI study findings, combination estrogen-progestin therapy increased women's risk for breast cancer, stroke, and pulmonary embolism. Discontinuation rates increased nearly seven-fold among women with diabetes and nearly six-fold among women with cardiovascular disease. Newton, Buist, Miglioretti, et al., J Gen Intern Med 20:350-6, 2005 (AHRQ grant HS11843).
Women respond differently to medications than men and should be proactive about their medication use.
Women take more medications than men. They also respond differently to medications and are more likely than men to suffer medication-related problems. Thus, women should be proactive about their medication use. They need to ask clinicians questions about their diagnosis, treatment, and medication use. It is important for women to make sure they understand the need for each medication they are prescribed, and they should be sure to take their medications according to their doctor's instructions. The author provides a number of other caveats for women related to medication use. Correa-de-Araujo, J Women's Health 14(1):12-15, 2005; see also pages 16-18 in the same journal. (Reprints, AHRQ Publication Nos. 05-R020 and 05-R021)* (Intramural).
Older women used more medications and had higher drug expenses than same-age men from 1999 to 2001.
Women aged 65 and older had expenditures for prescription medications that were 17 percent higher than men of the same age, according to this analysis of MEPS data for 1999, 2000, and 2001. Overall, older women spent an average of $1,178 per year, compared with $1,009 spent by older men. Also, women were somewhat more likely than men (92 percent vs. 88 percent) to use prescription drugs, with women purchasing almost 20 percent more prescription drugs on average than men. Correa-de-Araujo, Miller, Banthin, and Trinh, J Women's Health 14(1):73-81, 2005 (Reprints, AHRQ Publication No. 05-R019)* (Intramural).
Card offers tips to help women use medicines safely.
This two-sided card explains how medicines may work differently in women and men and what women can do to help make sure their medicines work for them. Tips are provided for creating a medication list, talking with pharmacists and other health care providers about medications, and finding out more information on safe medication use. Your Medicine: Play It Safe (AHRQ Publication No. 03(05)-0019-A)* (Intramural).

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Data Sources for Gender Research

The goal of gender-based research is to improve our understanding about disparities between men and women in the medical care provided and outcomes for certain conditions, most notably cardiovascular disease. A better understanding of the different health care needs and uneven distribution of health care resources across different populations can contribute to improvements in our nation's health care system and help target interventions where they are both needed and likely to have the most positive impact.

Article describes data sources useful for gender-based research.
The authors describe nine different underused data sources that are useful for gender-based analyses and research. They note that these resources offer great possibilities for future research, particularly with regard to some components of care that are particularly important to women. Moy and Dayton, Women's Health 17:334-7, 2007 (AHRQ Publication No. 08-R048)* (Intramural).

Medical Expenditure Panel Survey

In 1996, AHRQ launched the Medical Expenditure Panel Survey (MEPS), a nationally representative survey to collect detailed information on health status, health care use and expenses, and health insurance coverage for individuals and families in the United States, including nursing home residents. MEPS is helping the Agency to address many questions important to women, including how health insurance coverage, access to care, use of preventive care, the growth of managed care, changes in private health insurance, and other changes in the health care system are affecting the kinds, amounts, and costs of health care services used by women. For more information related to MEPS, go to http://www.meps.ahrq.gov.

Healthcare Cost and Utilization Project

The Healthcare Cost and Utilization Project (HCUP) is a family of health care databases and related software tools and products sponsored by AHRQ and developed through a Federal-State-industry partnership. HCUP includes the largest collection of longitudinal hospital care data in the United States, with all-payer, encounter-level information beginning in 1988. These databases enable research on a broad range of health policy issues that are pertinent to women, including the cost and quality of health services, access to care, and patient outcomes at the national, State, and local levels. HCUP comprises the following databases:

Nationwide Inpatient Sample (NIS), with inpatient data from a national sample of over 1,000 hospitals.
Kids' Inpatient Database (KID), a nationwide sample of pediatric inpatient discharges.
State Inpatient Databases (SID), which contain the universe of inpatient discharge abstracts from participating States.
State Ambulatory Surgery Databases (SASD), which contain outpatient data on surgical encounters.
State Emergency Department Databases (SEDD), which contain data from hospital-affiliated emergency departments.

HIVnet

HIVnet is a tool that provides information on inpatient and outpatient care use by individuals with HIV disease. This information is valuable for service providers, program planners, policymakers, and health services researchers. HIVnet is focused on health services delivery. HIVnet provides easy access to selected statistics on patterns of HIV-related care for all population groups, including women. These statistics are based on data collected by the HIV Research Network (HIVRN).

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More Information

For more information on AHRQ initiatives related to women's health, please contact:

Shakeh J. Kaftarian, Ph.D.
Senior Advisor, Women's Health and Gender Research
Agency for Healthcare Research and Quality
540 Gaither Road
Rockville, MD 20850
Telephone: 301-427-1550
Email:
Jackie.Kaftarian@ahrq.hhs.gov

For more information about AHRQ and its research portfolio and funding opportunities, visit the Agency's Web site at http://www.ahrq.gov.

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* Items marked with an asterisk (*) are available free from the AHRQ Clearinghouse. To order, contact the Clearinghouse at :

Phone: 800-358-9295 or request electronically by sending an E-mail to ahrqpubs@ahrq.gov.

Please use the AHRQ publication number when ordering.

Current as of April 2009
AHRQ Publication No. 09-PB002
(Replaces AHRQ Publication No. 06-P008)

Internet Citation:

AHRQ Women's Health Highlights: Recent Findings. Program Brief. AHRQ Publication No. 09-PB002, April 2009. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/research/womenh1.htm