- Title
- Health care use by older Australian women with asthma
- Creator
- Eftekhari, Parivash
- Relation
- University of Newcastle Research Higher Degree Thesis
- Resource Type
- thesis
- Date
- 2019
- Description
- Research Doctorate - Doctor of Philosophy (PhD)
- Description
- Asthma Prevalence is higher in Australia Compared with global rates with older women having the highest frequency of the disease. In older people asthma is found to be a different phenotype with more severe symptoms resulting in worse outcomes and higher mortality rates. Given that there is an increasing trend in global ageing which is associated with elevated prevalence of chronic diseases including asthma and ageing of baby boomers in Australia, there is need for research on asthma in older population especially older women. This thesis aimed to I) investigate the impact of asthma on mortality for older women while considering confounding factors; II) examine self-reported health service use for older women according to asthma status; III) investigate cross sectional and longitudinal associations between asthma groups and self-reported health service use, adjusting for predisposing, enabling and needs factors; IV) examine Medicare records for health service use by older women according to asthma status; and V) investigate cross sectional and longitudinal associations between asthma groups and Medicare for health service use while also considering predisposing factors, enabling factors and needs. Data from 1921-26 and 1946-51 cohorts of the Australian Longitudinal study on women's health linked with Medicare records were used in analyses of this thesis. Women were categorised into five mutually exclusive groups according to their asthma status (percentages shown for 1921-26 and 1946-51 cohorts respectively): 1) past asthma (4.2% and 6.4%); 2) prevalent asthma (8.5% and 10.2%); 3) incident asthma (5.3% and 8.9%); 4) bronchitis/emphysema (17.6% and 15.2%); and 5) never asthma (64.4% and 59.3%). Logistic regression and multinomial regressions were used to investigate the cross sectional associations between asthma groups and both Self-reported and administrative health service use taking into account the effect of predisposing, enabling and needs factors. Longitudinal analyses were conducted to investigate the association of asthma groups with health service use by older women over time adjusting for repeated measures of predisposing, enabling and needs factors. Findings from the studies showed that asthma was associated with higher mortality rates in older women from the 1921-26 cohort even after taking into account the effect of confounding factors. Larger proportions of women with asthma in both cohorts had comorbidities including heart diseases, diabetes, anxiety and depression. Women with asthma were more likely to have reported visits to their GPs/family doctors in a year compared with women without asthma even after adjusting for predisposing, enabling and needs factors. This finding was corroborated by results from the Medicare records, showing that asthma was associated with more frequent and longer visits even after taking into account the effect of predisposing, enabling and needs factors. Asthma was also associated with higher number of claims for specialist visits, after-hours GP visits, Chronic Disease Management (CDM) and Asthma Cycle of Care (ACC) items. After adjusting for asthma group, the use of these services, were mostly driven by possessing private health insurance and comorbidities. Although women with asthma had higher levels of health service use, the uptake of enhanced primary care items including assessments, CDM and ACC were low. Potentially, the better uptake and application of services subsidised by these items could improve the impact of asthma on older women’s quality of life and reduce asthma mortality rates in older women.
- Subject
- asthma; health service use; older; women; Asthma Cycle of Care; Chronic Disease Management; mortality; survival; Medicare Benefits scheme
- Identifier
- http://hdl.handle.net/1959.13/1402486
- Identifier
- uon:35035
- Rights
- Copyright 2019 Parivash Eftekhari
- Language
- eng
- Full Text
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| Thumbnail | File | Description | Size | Format | |||
|---|---|---|---|---|---|---|---|
| View Details Download | ATTACHMENT01 | Thesis | 8 MB | Adobe Acrobat PDF | View Details Download | ||
| View Details Download | ATTACHMENT02 | Abstract | 928 KB | Adobe Acrobat PDF | View Details Download |