Educational level, marital status and sex as social gender discharge determinants in chronic obstructive pulmonary disease exacerbations: a time-to-event analysis

  • Orazio Valerio Giannico | oraziovaleriogiannico@gmail.com Department of Biomedical Sciences and Human Oncology, University of Bari Aldo Moro, Italy. http://orcid.org/0000-0001-5375-8841
  • Immacolata Ambrosino Local Healthcare Unit of Bari, Health District 13, Bari, Italy.
  • Francesco Patano Department of Biomedical Sciences and Human Oncology, University of Bari Aldo Moro, Italy.
  • Cinzia Germinario Department of Biomedical Sciences and Human Oncology, University of Bari Aldo Moro, Italy.
  • Michele Quarto Department of Biomedical Sciences and Human Oncology, University of Bari Aldo Moro, Italy.
  • Anna Maria Moretti President of GISeG, Italian Group for Health and Gender, Bari, Italy.

Abstract

The aim of this study is to evaluate, in patients hospitalized for COPD exacerbation, how educational level, marital status and sex (social gender indicators) affect the home discharge probability (main effects) and how interact with each other in affecting this probability (effect modification). Data for all patients discharged with a principal diagnosis of COPD with exacerbation (ICD-9 491.21) by Apulian hospitals between 2013 and 2017 were retrieved from the National Hospital Discharge Register Database. A multivariable multi-stratified frailty cox proportional-hazard regression with interaction terms was fitted in order to assess the effect of sex, educational level and marital status on the time-to-event for home discharge through the estimation of hazard ratios. Adjusting for several patient and hospitalization characteristics and for healthcare facilities, low educational level (<8 years of schooling) is associated with a lower probability of being discharged to home in both sexes and in all marital status categories (HR 0.92, 95%CI 0.87-0.97, p=0.0020). Female sex is associated with a lower probability of being discharged to home only in married patients (HR 0.83, 95%CI 0.78-0.88, p<0.0001). Marital status different from married is associated with a lower probability of being discharged to home only in male patients, in particular single patients (HR 0.82, 95%CI 0.74-0.92, p=0.0009), separated or divorced patients (HR 0.71, 95%CI 0.58-0.86, p=0.0005) and widowed patients (HR 0.87, 95%CI 0.80-0.95, p=0.0018). Differently from findings about protective effect of education, the evidence of different effects of sex on home discharge probability among civil statuses and of different effect of civil status among sexes is supposed to be a proxy for social gender health and healthcare inequalities.

Dimensions

Altmetric

PlumX Metrics

Downloads

Download data is not yet available.
Published
2019-05-24
Info
Issue
Section
Pneumology - Original Articles
Keywords:
Chronic obstructive pulmonary disease, gender differences, educational level, marital status, female caregiver
Statistics
  • Abstract views: 909

  • PDF: 492
How to Cite
Giannico, O. V., Ambrosino, I., Patano, F., Germinario, C., Quarto, M., & Moretti, A. M. (2019). Educational level, marital status and sex as social gender discharge determinants in chronic obstructive pulmonary disease exacerbations: a time-to-event analysis. Monaldi Archives for Chest Disease, 89(2). https://doi.org/10.4081/monaldi.2019.1017

Most read articles by the same author(s)