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Sex differences in the management of patients hospitalized with ischemic cerebrovascular disease
S J Patrick1, J Concato, C Viscoli
1Department of Neurology, Yale University School of Medicine, New Haven, CT 06510, USA.
Insights
Women hospitalized for ischemic cerebrovascular disease receive fewer angiograms and carotid endarterectomies than men. However, these sex-based differences in treatment disappear when focusing solely on carotid artery disease.
Area of Science:
- Neurology
- Vascular Surgery
- Public Health
Background:
- Coronary artery disease management shows sex-based disparities.
- Investigating similar disparities in ischemic cerebrovascular disease (CVD) is crucial.
Purpose of the Study:
- To examine sex-based differences in the management of ischemic cerebrovascular disease.
- To compare rates of cerebral angiography and carotid endarterectomy between men and women.
Main Methods:
- Retrospective review of hospital discharge data from Connecticut over a decade.
- Analysis of cerebral angiography and carotid endarterectomy rates by sex.
- Crude and age-adjusted rates were calculated.
Main Results:
- Women (7.2%) underwent cerebral angiography less often than men (11.8%).
- Carotid endarterectomy rates were lower in women (5.7%) compared to men (10.6%).
- When restricted to carotid artery disease, sex differences in procedures were not significant.
Conclusions:
- Women with ischemic cerebrovascular disease receive less aggressive management than men.
- Observed disparities are not present when focusing on carotid artery disease, suggesting biological factors may play a role.
- Further research into sex-based biological differences in cerebrovascular disease is warranted.
Background And Purpose:
Previous studies suggest that the management of coronary artery disease differs for women compared with men. We examined this issue for ischemic cerebrovascular disease.
Methods:
We reviewed the use of angiography and carotid endarterectomy among patients discharged from Connecticut hospitals during 6 years over the past decade. Crude and age-adjusted rates of angiography and endarterectomy were determined for each sex.
Results:
Among 22,582 female and 19,729 male patients discharged, the rate of cerebral angiography was 11.8% for men and 7.2% for women; the age-adjusted odds ratio was 0.77 (95% confidence interval [CI], 0.72 to 0.82). The rate of endarterectomy was 10.6% for men and 5.7% for women; the age-adjusted odds ratio was 0.67 (95% CI, 0.62 to 0.72). The distribution of cerebrovascular disease type differed by sex, however, with carotid artery disease representing a larger proportion of men (12.2% [2415/19,729]) than women (6.9% [1554/22,582]) (chi 2 = 355.8, P < .0001). When restricted to this diagnosis, no sex differences exist (odds ratio for angiography, 1.00 [95% CI, 0.87 to 1.14] and for endarterectomy, 0.93 [95% CI, 0.81 to 1.07]).
Conclusions:
Overall, women hospitalized for ischemic cerebrovascular disease undergo fewer angiograms and are less likely to have carotid endarterectomy than men. These differences are not found when analysis is restricted to subjects with carotid disease and suggest that part of the difference in management may be due to biological differences between men and women.
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