Healthcare Utilization and Prevalence of Symptoms in Women with Menopause: A Real-World Analysis

Figures & data

Table 1 Demographic and Clinical Characteristics of the Study Population for Matched Cohort of Symptomatic Women vs Women in the Reference Group at Index Date (Date of First Menopause Symptom). (N=34,092). All N (%) Unless Otherwise Stated

	Reference Group (Controls) n=17,046	Symptomatic Women (Cases) n=17,046	P-value
Demographic
Age y, median (IQR)	49.00 (47.00, 51.00)	49.00 (48.00, 51.00)	0.802
District
Centre	10,808 (63.4%)	10,808 (63.4%)	1.00
North	3,088 (18.1%)	3,088 (18.1%)
South	3,150 (18.5%)	3,150 (18.5%)
Socioeconomic status*
1st (lowest)	5,521 (32.4%)	5,249 (30.8%)	0.018
2nd	3,422 (20.1%)	3,512 (20.6%)
3rd	3,381 (19.8%)	3,455 (20.3%)
4th (highest)	4,722 (27.7%)	4,830 (28.3%)
Clinical indices
Smoking status
Never	14,119 (82.8%)	14,552 (85.4%)	<0.001
Ever	2,384 (14.0%)	2,118 (12.4%)
Unknown	543 (3.2%)	376 (2.2%)
Deyo-Charlson Index
0	2,725 (16.0%)	2,796 (16.4%)	0.344
1	886 (5.2%)	887 (5.2%)
3	285 (1.7%)	261 (1.5%)
≥4	127 (0.7%)	103 (0.6%)
Comorbidities
Diabetes mellitus	831 (4.9%)	631 (3.7%)	<0.001
Cardiovascular disease	613 (3.6%)	607 (3.6%)	0.861
Hypertension	2,765 (16.2%)	2,620 (15.4%)	0.031
Chronic kidney disease	475 (2.8%)	459 (2.7%)	0.596
COPD	99 (0.6%)	68 (0.4%)	0.016
Osteoporosis	580 (3.4%)	416 (2.4%)	<0.001
Major depression	82 (0.5%)	103 (0.6%)	0.122
Other depression	848 (5.0%)	1,037 (6.1%)	<0.001
Anxiety	808 (4.7%)	1,107 (6.5%)	<0.001
Insomnia	228 (1.3%)	347 (2.0%)	<0.001
Hysterectomy
1 year before index	81 (0.5%)	100 (0.6%)	0.157
Medication use within 6 months before index
Anti-anxiety (hypnotics)	1,575 (9.2%)	2,001 (11.7%)	<0.001
SSRI	1,236 (7.3%)	1,416 (8.3%)	<0.001
SNRI	388 (2.3%)	476 (2.8%)	0.002
Bisphosphonates	177 (1.0%)	114 (0.7%)	<0.001

Notes: *Socioeconomic status is based on the poverty index of the member’s enumeration area, as defined by the 2008 National Census. The poverty index is based on parameters including household income, educational level, crowding, physical conditions and car ownership. A higher score indicates higher level of SES.

Abbreviations: COPD, chronic obstructive pulmonary disease; SSRI, selective serotonin reuptake inhibitors; SNRI, serotonin-norepinephrine reuptake inhibitor.

Table 2 Healthcare Utilization in the 1- Year Baseline Period (N=34,092)

	Reference Group (Controls) n=17,046	Symptomatic Women (Cases) n=17,046	P-value
Hospitalization
N (%)	902 (5.3%)	1,002 (5.9%)	0.018
Median (IQR) number of nights in the baseline year for those hospitalized	2 (1,4)	2 (1,4)	0.215
Median (IQR) number of separate hospitalizations	1 (1,1)	1 (1,1)	0.840
1	86.3%	85.9%	0.663
2	10.0%	10.0%
≥3	3.8%	4.1%
PCP visits
≥1	14,987 (87.9%)	15,856 (93.0%)	<0.001
≥5	9,403 (55.2%)	10,633 (62.4%)	<0.001
Median (IQR)	6 (3,10)	7 (4, 11)	<0.001
Gynecologist visits
≥1	7,590 (44.5%)	9,849 (57.8%)	<0.001
Median (IQR)	2 (1, 3)	2 (1,3)	0.084

Abbreviation: PCP, primary care physician.

Figure 1 One-year post-index prevalence of comorbid conditions for symptomatic women (cases) versus women in the reference group (controls), by age, N=34,092. *Significant difference between menopause and control cohorts.

Figure 2 One-year post-index prevalence of medication for symptomatic women (cases) versus women in the reference group (controls), by age N=34,092. *Significant difference between menopause and control cohorts.

Abbreviations: SSRI, selective serotonin reuptake inhibitors; SNRI, serotonin-norepinephrine reuptake inhibitor.

Table 3 Adjusted Odds Ratios Associated with Categorical Healthcare Utilization and Hysterectomy Procedures (Yes/No) in the Index Year (Using Conditional Logistic Regression)

	Reference Group (Controls) n=17,046 N (%)	Symptomatic Women (Cases) n=17,046 N (%)	Adjusted OR^a (95% CI)
Hospitalizations	960 (5.6%)	1,070 (6.3%)	1.102 (1.006, 1.207)
PCP visits	15,075 (88.4%)	16,086 (94.4%)	1.901 (1.734, 2.084)
Gynecologist visits	7,401 (43.4%)	16,196 (95.0%)	24.835 (22.357, 27.589)
Hysterectomy procedures (n=31,688)	52 (0.3%)	121 (0.8%)	2.262 (1.630, 3.140)

Notes: ^aAdjusted for age at diagnosis, SES, smoking, PCP visits, comorbidities at index: diabetes mellitus, osteoporosis, depression, anxiety, insomnia, drug use within 6 months before index: hypnotics, SSRI, SNRI, bisphosphonates.

Abbreviations: PCP, primary care physician; SES, socioeconomic status; SSRI, selective serotonin reuptake inhibitors; SNRI, serotonin-norepinephrine reuptake inhibitor.

Figure 3 One-year post-index prevalence of healthcare utilization for symptomatic women (cases) versus women in the reference group (controls), N=34,092. *Significant difference between menopause and control cohorts.

Table 4 Adjusted Odds Ratios Associated with the Frequency of Hospitalizations, Primary Care Physician Visits and Gynecologist Visits Using for Index Year (Using Generalized Linear Regression Modeling)

	Reference Group (Controls) n=17,046, Mean (SD)	Symptomatic Women (Cases) n=17,046, Mean (SD)	Adjusted OR^a (95% CI)	Added Number of Visits per Patient for Index Year
Hospitalizations	0.069 (0.326)	0.078 (0.348)	1.122 (1.033, 1.218)	0.01 (0,0.020)
PCP visits	6.912 (6.506)	8.23 (6.926)	1.154 (1.128, 1.181)	1.07 (0.890,1.25)
Gynecologist visits	0.941 (1.65)	2.052 (2.14)	2.154 (2.093, 2.216)	1.09 (1.030,1.14)

Notes: ^aAdjusted for age at diagnosis, SES, smoking, PCP visits, comorbidities at index: diabetes, Osteoporosis, depression, anxiety, insomnia, drug use within 6 months before index: hypnotics, SSRI, SNRI, bisphosphonates.

Abbreviations: PCP, primary care physician; SES, socioeconomic status; SSRI, selective serotonin reuptake inhibitors; SNRI, serotonin-norepinephrine reuptake inhibitor.