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Cardiovascular disease is the greatest health threat to women in the United States.
Identifying the reason for that inequity will take time and research, according to Shakeh Kaftarian, senior advisor for women's health and gender research at the Agency for Healthcare Research and Quality (AHRQ).
"We need to look at this from a very multifactorial, multidisciplinary perspective," she says.
Part of the problem may lie in the fact that cardiovascular disease manifests differently in men than women. Women tend to get heart disease about 10 years later in life than men, are more likely to have coexisting chronic conditions, and present different symptoms when suffering a heart attack. Symptoms may be more subtle in women. As a result, women and their doctors mistakenly attribute their symptoms to other conditions, such as depression, heartburn or stress.
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A brief last year from AHRQ cited numerous agency-supported studies published between 2005 and 2008 indicating that women with cardiovascular disease may not be treated as aggressively as men. These inequities explain why 42% of women who suffer heart attacks die within one year, compared with 24% of men, according to the brief.
Studies found gender differences in everything from care processes to the use of low-dose aspirin therapy and transfusions during coronary bypass graft surgery.
One study, led by Ann Chou at the University of Oklahoma, evaluated plan-level performance on HEDIS measures using a national sample of Medicare and commercial health plans. Researchers found more than half the commercial plans showed that among patients with diabetes and those who had a recent cardiovascular procedure or heart attack, there was a disparity of 5% or more in favor of men for cholesterol control measures. No commercial plans showed such disparities in favor of women. Gender differences favoring men were even greater for Medicare plans.
Eliminating gender disparities in selected preventive care measures for cardiovascular disease alone has the potential to reduce major cardiac events, including death, by 4,785 to 10,170 per year among persons enrolled in U.S. health plans, Chou and colleagues reported in the study.
In a separate study to assess gender differences in cardiovascular disease and diabetes care, RAND researcher Chloe Bird studied HEDIS performance measures from 10 commercial and nine Medicare plans. Adjusting for covariates, researchers found significant gender differences on five of 11 measures among Medicare enrollees, with four favoring men. Among commercial enrollees, researchers found significant gender differences for eight of 11 measures, with six favoring men.
On the whole, health plans are doing a better job managing cardiovascular disease thanks largely employers' "holding the light to their performance," says Dennis White, vice president of the National Business Coalition on Health, which published a progress report on the subject last spring.
"The power of the public eye has worked," he says.
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