Differences in the use of procedures between women and men hospitalized for coronary heart disease
Open accessAbstract
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.
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Considering as radically different certain situations that are, to some extent, similar in health for men and women can eventually produce inequities such as the fact that for the same coronary pathological condition, women do not receive the same health care or the same medical and surgical treatment.
“Considering as radically different certain situations that are, to some extent, similar in health for men and women can eventually produce inequities such as the fact that for the same coronary pathological condition, women do not receive the same health care or the same medical and surgical treatment (Ayanian & Epstein, 1991; Canto et al., 2000; Melberg, Kindervaag, & R”
From Health From a Gender Perspective (2017) · cites this paper as Ayanian & Epstein, 1991
When they have the same cardiopathological condition, women do not receive the same medical and surgical treatment; nor do they have the same probability of receiving the treatment that will potentially save their lives.
“Not realizing that cardiovascular diseases are also the leading cause of mortality in women may produce effects like that noted by Ayanian and Epstein (1991), showing that when they have the same cardiopathological condition, women do not receive the same medical and surgical treatment; nor do they have the same probability of receiving the treatment that will potentially save their”
From Health From a Gender Perspective (2017) · cites this paper as Ayanian & Epstein, 1991
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- Authors
- Ayanian, J. Z., & Epstein, A. M.
- Affiliations
- Brigham and Women's Hospital (US)
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 1991-07-25
- Volume
- 325
- Issue
- 4
- Pages
- 221-225
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- OpenAlex
- W2331499127
- Cited by
- 1,188
- References
- 0
- Citations by year
- 2026: 5 · 2025: 11 · 2024: 23 · 2023: 14 · 2022: 11 · 2021: 14 · 2020: 14 · 2019: 16 · 2018: 15 · 2017: 8 · 2016: 18 · 2015: 24 · 2014: 16 · 2013: 30 · 2012: 23
- FWCI
- 77.07
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- New England Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- DigitalGeorgetown (Georgetown University Library) (submittedVersion)
- Funders
- Agency for Healthcare Research and Quality (1 PO1 HS 06341)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Sex and Gender in Healthcare
- Health Sciences › Medicine › Surgery › Coronary Interventions and Diagnostics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Acute Myocardial Infarction Research
- Keywords
- coronary artery disease, sex differences, coronary angiography, coronary revascularization, coronary artery bypass grafting, percutaneous transluminal coronary angioplasty, acute myocardial infarction, underuse of care, women's health, hospital discharge data
- MeSH terms
- Adult, Aged, Aged, 80 and over, Angiography, Coronary Artery Bypass, Coronary Disease, Female, Hospitalization, Humans, Male, Maryland, Massachusetts, Middle Aged, Myocardial Infarction, Practice Patterns, Physicians', Prejudice, Retrospective Studies, Sex Factors, Models, Statistical, Odds Ratio, Women's Health, Coronary Angiography
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