Differences in the use of procedures between women and men hospitalized for coronary heart disease

Article Abstract:

Coronary heart disease (CHD) is the major cause of illness and death of men and women in the United States. In the past 40 years, the incidence (number of new cases) of CHD has decreased in men and increased in women. Advances in diagnosis and treatment have decreased CHD mortality among both sexes during the past 20 years. However, some studies have indicated that the new technologies are not used equally in men and women. More specifically, these studies suggest that advances in the diagnosis and treatment of CHD are made more available to men, who undergo these procedures more often and earlier in the progression of the disease than women. This could result in a better prognosis for men and a worse outcome for women. To determine whether men and women with CHD are treated differently, the medical records of patients who were hospitalized in Maryland and Massachusetts in 1987 were analyzed. In Massachusetts, of the 49,623 cases reviewed, 42.6 percent were women; in Maryland, of the 33,159 cases reviewed, 45.9 percent were women. Coronary angiography, an invasive diagnostic imaging technique, was performed more frequently in males than females, with 27.5 and 28.7 percent of the men and 16.1 and 17.7 percent of the women in Massachusetts and Maryland, respectively, undergoing this procedure. Coronary bypass surgery and percutaneous transluminal coronary (balloon) angioplasty are designed to increase blood flow to the heart in patients with CHD. These revascularization techniques were performed on 15.5 and 14.1 percent of the men and 7.4 and 6.5 percent of the women in Massachusetts and Maryland, respectively. The numbers of men and women undergoing coronary angiography and revascularization were similar when only data from cases with an initial diagnosis of heart attack were used. These findings indicate that there are gender-related differences in the types of diagnostic procedures and treatments offered to patients with CHD. It is possible that coronary bypass surgery is performed too often in males or not often enough in females, and men may tend to have more severe cases of CHD than women. However, further studies are needed to ascertain if women are being under-treated for CHD. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Reports, Women, Coronary heart disease, Women's health, Discrimination in medical care, Medical care discrimination

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The relation between health insurance coverage and clinical outcomes among women with breast cancer

Article Abstract:

Women without private health insurance may be diagnosed with breast cancer later in the disease and have a lower survival rate than women with private health insurance. A review of the medical records of 4,675 New Jersey women diagnosed with breast cancer between 1985 and 1987 found that 5.9% of the women were uninsured, 2.5% were covered by Medicaid and the remaining women had private medical insurance. The uninsured women and the women covered by Medicaid were less likely to be white, were younger and were more likely to be living in poor communities. The risk of dying from breast cancer was 49% higher among uninsured women and 40% higher for women with Medicaid than for women with private insurance. Uninsured women 50 to 64 years old and in Medicaid-insured women 35 to 49 years old were more likely to have advanced disease. Early treatment of breast cancer can save women's lives. Women who are uninsured or who are covered by Medicaid would benefit from earlier screening and more aggressive therapy.

Economic aspects, Mortality, Breast cancer, Health insurance

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Racial differences in the use of revascularization procedures after coronary angiography

Article Abstract:

Whites may be more likely than blacks to have a revascularization procedure after coronary angiography. Revascularization procedures used to treat coronary heart disease include percutaneous transluminal coronary angioplasty (PTCA) and coronary artery bypass graft (CABG) surgery. A study examined the use of PTCA and CABG surgery among 27,485 Medicare patients between 65 and 74 years old with coronary heart disease who had coronary angiography in the hospital. White patients were almost two times more likely to undergo a revascularization procedure after coronary angiography than black patients. Both white men and white women were more likely to have a revascularization procedure. Racial differences in the use of revascularization were found at all types of hospitals except those in rural areas. These differences may be caused by a variety of factors.

Demographic aspects, Race, Coronary artery bypass, Transluminal angioplasty, Balloon angioplasty

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