Evidence grows that women are treated less aggressively for heart disease than men
http://www.100md.com
《英国医生杂志》
Men in England who have a heart attack are almost twice as likely to have surgery as women with the same condition.
Men are twice as likely as women to have a myocardial infarction, and once they have a heart attack they are almost twice as likely to have surgery for it, according to research based on almost a decade of NHS data. Older people also face inequity.
"As women tend to present with coronary heart disease at older ages, this indicates that they may be the victims of a 慸ouble whammy?of inequity," say researchers, who point out that there is no evidence that women are less likely to benefit from surgery.
The authors, who report their findings in Social Science and Medicine (2004;59:2499-507), say that although previous studies have looked at inequity, these have used data from either small geographical areas or from one point in time.
In the study, the researchers, from the University of Bristol and the South West Public Health Observatory, looked at sex and age differences in patients having coronary revascularisation procedures in England over a nine year period.
They analysed trends from 1991 to 1999 by comparing admissions for acute myocardial infarction and coronary artery bypass grafting and percutaneous transluminal coronary angioplasty.
The results show that to have achieved equity with men (after allowance was made for the differences in need) more than 12 000 additional coronary artery bypass grafting procedures and 5000 more percutaneous transluminal coronary angioplasty procedures would have been needed.
The researchers, who found that the inequities remained constant throughout the study period, say that it seems that women and older people in England are probably receiving less revascularisation than their need would indicate.
They say several possible reasons exist for the inequity and that it is unlikely that clinical differences can explain the threefold to fivefold difference in revascularisation rates.
"It is possible that some of these inequities may be explained by men (and younger people) being more likely to want, ask for, be referred and selected for procedures than are women and older people during the complex treatment process," says the report.
The lead author, Dr Mary Shaw, said, "Although clinical differences could account for some of the difference, and there may be different rates of comorbidity among men and women that may make them more or less likely to be recommended for surgery, it is very unlikely this accounts for all of this substantial inequity.
"We are suggesting that social and cultural elements also play a role as well as clinical indications. The medical professions may manage male and younger patients more aggressively than their female and older counterparts so that the former are given surgery whilst the latter are managed medically."(Abergavenny Roger Dobson)
Men are twice as likely as women to have a myocardial infarction, and once they have a heart attack they are almost twice as likely to have surgery for it, according to research based on almost a decade of NHS data. Older people also face inequity.
"As women tend to present with coronary heart disease at older ages, this indicates that they may be the victims of a 慸ouble whammy?of inequity," say researchers, who point out that there is no evidence that women are less likely to benefit from surgery.
The authors, who report their findings in Social Science and Medicine (2004;59:2499-507), say that although previous studies have looked at inequity, these have used data from either small geographical areas or from one point in time.
In the study, the researchers, from the University of Bristol and the South West Public Health Observatory, looked at sex and age differences in patients having coronary revascularisation procedures in England over a nine year period.
They analysed trends from 1991 to 1999 by comparing admissions for acute myocardial infarction and coronary artery bypass grafting and percutaneous transluminal coronary angioplasty.
The results show that to have achieved equity with men (after allowance was made for the differences in need) more than 12 000 additional coronary artery bypass grafting procedures and 5000 more percutaneous transluminal coronary angioplasty procedures would have been needed.
The researchers, who found that the inequities remained constant throughout the study period, say that it seems that women and older people in England are probably receiving less revascularisation than their need would indicate.
They say several possible reasons exist for the inequity and that it is unlikely that clinical differences can explain the threefold to fivefold difference in revascularisation rates.
"It is possible that some of these inequities may be explained by men (and younger people) being more likely to want, ask for, be referred and selected for procedures than are women and older people during the complex treatment process," says the report.
The lead author, Dr Mary Shaw, said, "Although clinical differences could account for some of the difference, and there may be different rates of comorbidity among men and women that may make them more or less likely to be recommended for surgery, it is very unlikely this accounts for all of this substantial inequity.
"We are suggesting that social and cultural elements also play a role as well as clinical indications. The medical professions may manage male and younger patients more aggressively than their female and older counterparts so that the former are given surgery whilst the latter are managed medically."(Abergavenny Roger Dobson)