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Morbidity Experiences and Disability Among Canadian Women

Marie DesMeules, MSc (Health Canada); Linda Turner, PhD (CIHI); and Robert Cho (Health Canada)

Health Issue

Overall morbidity is commonly defined as "departure from an overall state of health". Although this concept is relatively narrow in the context of a broad population health assessment framework, it is nevertheless an essential component to consider when describing the health of a population.

Women have a longer life expectancy than men (as described in the chapter on "Mortality and Life Expectancy of Canadian Women"), but they do not appear to have a similar advantage when morbidity is defined in a variety of ways (e.g. hospitalization rates, prevalence of chronic conditions, or disability). Canadian data from health surveys and hospital morbidity databases support these findings. No single explanation fully accounts for these sex discrepancies, which should, rather, be examined in the context of biological/medical, social, economic, and environmental determinants.

The objectives of this chapter are to provide further insight into the overall morbidity experiences of Canadian women. The Canadian Hospital Morbidity Database (2000-2001) and the Canadian Community Health Survey (2000-2001) were used to examine inpatient hospital morbidity, prevalence of chronic conditions, and disability. Men and women, and subgroups of women, are compared and key determinants of morbidity are identified.

Key Findings

• Although all-cause, age-standardized hospitalization (inpatient) rates have been decreasing in recent years, they have consistently been approximately 20% higher among women than among men. Average length of hospital stay in acute-care facilities was comparable among women and men.
• The most common causes of hospitalization for women are pregnancy and childbirth (more than 50% of all hospitalizations among women aged 20-44), circulatory diseases, and digestive diseases. Women are more frequently hospitalized for cancer, mental disorders, and musculo-skeletal diseases than men, whereas men are hospitalized more for circulatory and respiratory diseases, and injury/poisoning.
• When pregnancy and childbirth were excluded from the all-cause hospitalization rates, women's hospital morbidity rates are lower than men's. When only "normal" deliveries (no complications) were excluded, hospital morbidity rates remain higher among women.
• Women had slightly lower rates than men (354 versus 391 per 100,000 respectively) of hospitalization for ambulatory-care sensitive conditions (which include asthma and other conditions for which hospital morbidity can be prevented through proper ambulatory care and adherence to self-care), indicating a possibly higher rate of utilization of ambulatory care services for these conditions among women.
• Reported long-term disability is more frequent among women than men (22.6% versus 19.6% respectively, a female-to-male ratio of approximately 1.15), but was comparable among those in long-term care facilities. Severe disability is more common among women.
• The prevalence of having at least one reported chronic condition is greater among women. Interestingly, this higher prevalence was observed mainly for comorbidity (two or more conditions); the prevalence of only one condition was comparable between women and men.
• Adjusting for age, reported chronic conditions, education, household income, and smoking, multiple logistic regression showed that women have an odds ratio of 1.07 (confidence interval 1.03, 1.12) for disability as compared with men. These factors explain a large portion of the observed sex differences in disability prevalence.
• Women with a disability are less likely than men to be in a partnered relationship, and have lower income and employment rates, and less tangible social support.all representing added vulnerabilities.

Data Gaps and Recommendations

The authors identified the following data gaps and made the following recommendations:

• The overall lower rate of hospital morbidity among women indicates that their morbidity may be less acute and that they may make greater use of ambulatory care. This type of analysis would be enhanced through further examination of the level of "urgency" of care and the proportion of women's hospitalizations due to elective procedures. Information such as disease severity at referral would be key in examining gender differences in morbidity. Determinants of the observed higher hospital morbidity in adult women aged 20.44 should be examined more comprehensively.
• As more comprehensive and recent national morbidity databases, such as chronic and long-term care data and trauma registries, are developed, capacity for sex and gender comparisons in morbidity will be enhanced.
• The impact of disability on Canadian women's health is substantial. More comprehensive studies of the gender-relevant social and economic characteristics of women with disabilities are needed to develop enhanced interventions in this area, and will be facilitated by the recent Participation and Activity Limitation Survey (2001). The role of modifiable factors (e.g. access to timely and appropriate care, socio-economic factors) and non-modifiable factors (e.g. biological, disease severity) in women's versus men's risk of disability needs further study.
• Currently available measures of disability (e.g. the Health Utility Index) are based mainly on physical and sensory functioning (e.g. walking, hearing) and may have limitations for use in gender-sensitive analyses. Other factors that may contribute significantly to disability among women (e.g. depression, severe fatigue, or chronic stress) should be further explored.

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