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Gender differences in the treatment of cerebrovascular disease
S Ramani1, S Byrne-Logan, K M Freund
1Evans Department of Medicine, Boston Medical Center, Massachusetts 02118, USA.
Insights
Women hospitalized for stroke undergo significantly fewer carotid endarterectomies than men, with this disparity widening with age. Further research is needed to understand the reasons and implications of this gender difference in stroke treatment.
Area of Science:
- Neurology
- Vascular Surgery
- Health Services Research
Background:
- Previous research indicates gender disparities in invasive procedures for coronary artery disease.
- Gender differences in cerebrovascular disease treatment, specifically stroke, are less understood.
- Carotid endarterectomy is a key surgical intervention for stroke prevention.
Purpose of the Study:
- To investigate and quantify gender-based differences in the utilization of carotid endarterectomy for stroke treatment.
- To explore how age and comorbidity influence these gender disparities in stroke care.
Main Methods:
- Secondary analysis of a nationally representative Medicare database from 1992.
- Inclusion of patients aged 65-84 hospitalized for stroke (all strokes group) and those with precerebral arterial occlusion/stenosis (carotid disease subgroup).
- Calculation of female-to-male relative risks (RR) for carotid endarterectomy, with adjustments for age and comorbidity using logistic regression.
Main Results:
- Women comprised 3,356 of the 6,283 patients in the all strokes group.
- The overall age-adjusted female-to-male RR for carotid endarterectomy was 0.69 in the all strokes group and 0.77 in the carotid disease subgroup.
- The RR significantly decreased with increasing age, dropping to 0.39 for women aged 80-84 in the all strokes group, even after controlling for comorbidity.
Conclusions:
- Women hospitalized for stroke are less likely to undergo carotid endarterectomy compared to men.
- The observed gender gap in stroke treatment widens with advancing age.
- Further investigation is warranted to elucidate the underlying causes and clinical significance of this treatment disparity.
Objective:
Previous studies have shown that women receive fewer invasive procedures for the treatment of coronary artery disease than men, but gender differences in cerebrovascular disease have not been well studied. Our objective was to explore differences in the treatment of stroke between men and women.
Design:
Secondary database analyses.
Study Participants:
We examined the use of carotid endarterectomy in a nationally representative sample of Medicare enrollees aged 65 to 84, hospitalized for a principal diagnosis of stroke in 1992, the "all strokes group". We also studied a subgroup of patients, the "carotid disease subgroup", admitted with a principal diagnosis of precerebral arterial occlusion and stenosis or transient cerebral ischemia.
Measurements:
We determined rates of carotid endarterectomy for the all strokes group within gender and age groups and calculated corresponding female-to-male relative risks (RR) and 95% confidence intervals (CI). We also performed similar analyses for the carotid disease subgroup. We then used logistic regression to estimate the relative risk of use of carotid endarterectomy for women, controlling for age and comorbidity.
Results:
The all-strokes group consisted of 3,356 women and 2,927 men, of whom 1,009 women and 990 men were in the carotid disease subgroup. The overall age-adjusted female-to-male relative risk of undergoing carotid endarterectomy for those aged 65 to 84 was 0.69 (95% CI, 0.64-0.74) in the all strokes group and 0.77 (95% CI, 0.72-0.82) in the carotid disease subgroup. In both analyses, the RR became more pronounced with increasing age. In the all strokes group, for example, the RR was 0.80 (0.70-0.92) for those aged 65 to 69 and 0.39 (0.32-0.48) for those aged 80 to 84. The RR for the all strokes group remained similar in magnitude even after controlling for comorbidity (RR, 0.63 and 95% CI, 0.59-0.70).
Conclusion:
We conclude that women hospitalized for strokes undergo fewer carotid endarterectomies than men. Further studies are needed to examine the reasons for and implications of this gender difference.