First to Health

How are women treated differently in the healthcare system?

Here’s a few challenges in women’s health in the US based on extensive research studies as documented by the US Dept of Health and Human Services:
http://www.ahrq.gov/research/womenh1.htm

Heart disease is the number one killer of women in the United States yet:

1a) Women with atherosclerosis and high cholesterol receive less intense cholesterol management than men:

The researchers examined cholesterol management of 243 primary care patients from one academic medical center. The patients had coronary heart disease, cerebrovascular disease, or peripheral vascular disease and high (over 130 mg/dl) low-density (bad) cholesterol. Cholesterol management by either medication adjustments or LDL monitoring occurred at 31.2 percent of women’s visits and 38.5 percent of men’s visits. **Women were 23 percent less likely than men to have their cholesterol managed.**

Persell, Maviglia, Bates, and Ayanian, J Gen Intern Med 20:123-30, 2005 (AHRQ grant T32 HS00020)

1b) Existing heart disease is undiagnosed in half of women who have a first heart attack:

Many women who suffer a first heart attack have cardiac risk factors—such as high blood pressure, obesity, and diabetes—that have not been treated and represent missed opportunities to prevent heart problems in women. The researchers reviewed medical records of 150 women in one Minnesota county who suffered a heart attack between 1996 and 2001. Over the 10 years preceding their first heart attack, the women made a total of 8,732 outpatient visits and had 457 hospitalizations, but only **52 percent of the women** had been diagnosed with heart disease. About 80 percent of women with high blood pressure were treated with antihypertensive medications, but only **28 percent of women** were prescribed drug therapy for high cholesterol or lipid levels.

Yawn, Wollan, Jacobsen, et al., J Women’s Health 13(10):1087-100, 2004 (AHRQ grant HS10239).

1c) Women and men with cardiovascular disease and high cholesterol may receive different levels of treatment:

This study found that among people with CVD, men have their cholesterol measured more often, are treated more aggressively (e.g., with statins), and have lower levels of so-called "bad" cholesterol or LDL-C than women.

Kim, Hofer, and Kerr, J., Gen Intern Med 18:854-63, 2003 (AHRQ grant HS11540)

1d) Lack of research on women limits usefulness of studies on CHD:

Although CHD causes more than 250,000 deaths in women each year, much of the research in the last 20 years on CHD has either **excluded women entirely or included only limited numbers of women**. Two reviews focused on CHD in women were conducted recently by AHRQ’s Evidence-based Practice Center (EPC) at the University of California, San Francisco/Stanford. They examined the usefulness of various lab tests and treatments for CHD in women, the role of exercise, and the effectiveness of behavioral changes in lowering CHD risk in women.

Copies of the two reports, Results of a Systematic Review of Research on Diagnosis and Treatment of Coronary Heart Disease in Women, Evidence Report/Technology Assessment No. 80 (AHRQ Publication No. 03-E035 full report; 03-E034 summary) and Diagnosis and Treatment of Coronary Heart Disease in Women: Systematic Reviews of Evidence on Selected Topics, Evidence Report/Technology Assessment No. 81 (AHRQ Publication No. 03-E037, full report; 03-E036 summary) are available from AHRQ (contract 290-97-0013).

1e) Insurance status does not explain male-female differences in heart attack treatments and outcomes:

According to this study of more than 327,000 men and women who had a heart attack between 1994 and 1997, women received fewer cardiac treatments and procedures and had worse outcomes than men, but insurance status did not explain the disparities. Regardless of insurance status, women generally were less likely than men to receive aspirin, beta-blockers, intravenous heparin, or nitrate therapies within the first 24 hours of hospital admission. Also, women were much less likely than men to undergo coronary angiography, angioplasty, or coronary bypass surgery, and they were significantly more likely than men to die in the hospital.

Canto, Rogers, Chandra, et al., Arch Int Med 162:587-93, 2002 (AHRQ grant HS08843).