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Differences in the use of procedures between women and men hospitalized for coronary heart disease
1Department of Medicine, Brigham and Women's Hospital, Boston, MA.
Insights
Men with coronary heart disease receive more diagnostic and therapeutic procedures than women. This study analyzed coronary angiography and revascularization rates in Massachusetts and Maryland, finding significant disparities.
Area of Science:
- Cardiology
- Health Services Research
- Gender Health Disparities
Background:
- Previous studies indicated gender-based variations in cardiovascular procedure utilization.
- These variations were primarily observed at individual hospital levels.
Purpose of the Study:
- To determine if observed gender differences in coronary heart disease (CHD) procedures are generalizable.
- To analyze disparities in major diagnostic and therapeutic procedures between men and women hospitalized for CHD.
Main Methods:
- Retrospective analysis of coronary angiography and revascularization data from 1987 in Massachusetts and Maryland.
- Involved 49,623 discharges in MA and 33,159 in MD.
- Used multiple logistic regression, controlling for diagnosis, age, comorbidities, race, and insurance.
Main Results:
- Men had significantly higher adjusted odds for undergoing coronary angiography (28% higher in MA, 15% in MD) and revascularization (45% higher in MA, 27% in MD).
- Analysis limited to acute myocardial infarction patients confirmed similar male-to-female odds ratios for procedures.
- Findings remained statistically significant across both states.
Conclusions:
- Women hospitalized for CHD undergo fewer major diagnostic and therapeutic procedures compared to men.
- The observed differences may indicate appropriate care variations, underuse in women, or overuse in men.
- Further research is needed to investigate the causes and patient outcome implications of these gender disparities.
Background And Methods:
Previous studies at individual hospitals have reported differences in the use of major diagnostic and therapeutic procedures for women and men with coronary heart disease. To assess whether these differences can be generalized, we performed retrospective analyses of coronary angiography and revascularization (coronary-artery bypass surgery or percutaneous transluminal coronary angioplasty) in women and men hospitalized for coronary heart disease in 1987, using abstract data on 49,623 discharges in Massachusetts and 33,159 discharges in Maryland. We used multiple logistic regression to estimate the adjusted odds of the use of a procedure, controlling for principal diagnosis, age, secondary diagnosis of congestive heart failure or diabetes mellitus, race, and insurance status.
Results:
The adjusted odds of undergoing angiography were 28 percent and 15 percent higher for men than for women in Massachusetts and Maryland, respectively (95 percent confidence intervals for the odds ratios, 1.22 to 1.35 and 1.08 to 1.22). The respective adjusted odds of undergoing revascularization were 45 percent and 27 percent higher for men than for women (95 percent confidence intervals, 1.35 to 1.55 and 1.16 to 1.40). Because these differences could be related to differing thresholds for hospital admission, we performed a second analysis limited to patients with diagnosed acute myocardial infarction (11,865 discharges in Massachusetts and 6894 discharges in Maryland), a group in which all patients would be expected to receive hospital care. The male-to-female odds ratios in both states remained similar in magnitude and were statistically significant for angiography and revascularization.
Conclusions:
These findings demonstrate that women who are hospitalized for coronary heart disease undergo fewer major diagnostic and therapeutic procedures than men. These differences may represent appropriate levels of care for men and women, but it is also possible that they reflect underuse in women or overuse in men. Further study should assess the cause of these differences and their effect on patients' outcomes.