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Published on: September 26, 2018
Gender inequalities in cardiovascular risk factor assessment and management in primary healthcare
Karice K Hyun1, Julie Redfern1, Anushka Patel1
1The George Institute for Global Health, Sydney Medical School, University of Sydney, Sydney, Australia.
Insights
Australian women receive less cardiovascular disease risk assessment but are more likely to be prescribed preventive medications, with age-based variations. This highlights gender disparities in cardiovascular risk management in primary care.
Area of Science:
- Cardiology
- Primary Health Care
- Health Services Research
Background:
- Cardiovascular disease (CVD) risk assessment and management are crucial in primary healthcare.
- Understanding gender-based differences in CVD risk factor assessment and treatment is essential for equitable care.
Purpose of the Study:
- To quantify contemporary differences in cardiovascular disease (CVD) risk factor assessment and management between women and men in Australian primary healthcare services.
Main Methods:
- Utilized data from the Treatment of Cardiovascular Risk using Electronic Decision Support study (2012) involving 53,085 patients from 60 Australian primary healthcare services.
- Employed multivariable logistic regression to compare CVD risk factor assessment rates and guideline-recommended medication prescriptions between genders, adjusting for demographic and clinical factors.
Main Results:
- Women were less likely than men to have sufficient risk factors measured for CVD risk assessment (OR: 0.88).
- Among patients with or at high risk of CVD, women were more likely to be prescribed guideline-recommended medications (OR: 1.12).
- Significant age heterogeneity was observed: younger women (35-54 years) were less likely to receive medications (OR: 0.63), while older women (≥65 years) were more likely (OR: 1.34) compared to men.
Conclusions:
- Australian women face disparities in CVD risk factor measurement within primary care.
- While older women with CVD risk benefit from increased medication prescription, younger women experience the opposite, indicating age- and gender-specific management gaps.
Objectives:
To quantify contemporary differences in cardiovascular disease (CVD) risk factor assessment and management between women and men in Australian primary healthcare services.
Methods:
Records of routinely attending patients were sampled from 60 Australian primary healthcare services in 2012 for the Treatment of Cardiovascular Risk using Electronic Decision Support study. Multivariable logistic regression models were used to compare the rate of CVD risk factor assessment and recommended medication prescriptions, by gender.
Results:
Of 53 085 patients, 58% were female. Adjusting for demographic and clinical characteristics, women were less likely to have sufficient risk factors measured for CVD risk assessment (OR (95% CI): 0.88 (0.81 to 0.96)). Among 13 294 patients (47% women) in the CVD/high CVD risk subgroup, the adjusted odds of prescription of guideline-recommended medications were greater for women than men: 1.12 (1.01 to 1.23). However, there was heterogeneity by age (p <0.001), women in the CVD/high CVD risk subgroup aged 35-54 years were less likely to be prescribed the medications (0.63 (0.52 to 0.77)), and women in the CVD/high CVD risk subgroup aged ≥65 years were more likely to be prescribed the medications (1.34 (1.17 to 1.54)) than their male counterparts.
Conclusions:
Women attending primary healthcare services in Australia were less likely than men to have risk factors measured and recorded such that absolute CVD risk can be assessed. For those with, or at high risk of, CVD, the prescription of appropriate preventive medications was more frequent in older women, but less frequent in younger women, compared with their male counterparts.
Trial Registration Number:
12611000478910, Pre-results.
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