Date of Conferral

2021

Degree

Ph.D.

School

Public Health

Advisor

Hadi Danawi

Abstract

Heavy menstrual bleeding (HMB) is a well-recognized health issue among women of reproductive age. The characteristics and demographics of women in the community with HMB who present at the emergency department (ED) are not well described. This research aimed to describe the cohort of women who seek treatment at the ED. The Healthcare Cost and Utilization Project 2016 National Emergency Department Sample was examined. The theory of reasoned action predicts that women who present at the ED are exhibiting health seeking behavior. From 32 million records, the inception cohort identified N = 111,555 cases. Using national estimation weights, this translates to approximately 509,833 ED visits in the United States for HMB. The majority of the cohort, 39.59%, came from the lowest median household income quartile by ZIP code (under $42,999). Women with anemia were significantly older than the overall cohort. The greatest incidence of anemia was in women aged 40 to 49 years, 7.41%. Four logistic regression models examining the whole cohort and three comorbidities (anemia, hypertension, and diabetes) found age to be a significant predictor of hospitalization. Low income was also a significant predictor of hospitalization. The proportion hospitalized in the lowest household income group was significantly greater versus each of the other three quartiles, p < 0.001. Women living in the rural locations with the lowest household income had the highest proportion of hospitalizations. Women of economic disadvantage are most likely to use the ED for medical care. Residing in rural areas may lead to health avoidance until the severity of symptoms necessitates hospitalization. These findings signify a silent public health burden.

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