Why Women Get Less Heart Care (And What They Should Do)
More women die each year of heart disease than men, yet they're less likely than men to get screening tests and treatment to prevent the disease. That's the finding of a new study from Rand, which examined the medical records of 50,000 men and women enrolled in either Medicare or a private managed-care plan. Study author Chloe Bird, a sociologist at Rand,spoke to U.S. News about the implications for women.
Q: What did your study find?
A: The most important thing we found is that on a variety of measures related to cardiovascular disease and diabetes, women were receiving poorer quality of care than men. In particular, women insured by Medicare were 22 percent less likely to receive cholesterol-control drugs and guidance after a cardiac event and were 16 percent less likely to achieve cholesterol control if they were diabetic. Among the privately insured, they were 15 percent less likely to have the recommended drug treatment, a beta blocker, after a heart attack. These are established treatments for reducing morbidity and mortality.
Q: Could some other reason, besides gender, be to blame for the disparity?
A: We controlled for racial, ethnic, and socioeconomic disparities, so the differences went above and beyond these. With our study, the playing field was much more leveled. All the patients had insurance and were already diagnosed with diabetes or heart disease. We would expect to find an even larger disparity than what we saw in our study between, say, a wealthy white male and a poor African-American female. The fact that we found any disparities at all within this study is certainly disconcerting. We have a lot of reason to believe it's time to act.
Q: Why are women not getting these treatments?
A: In general, it's not some across-the-board lack of attention on the part of women or discrimination by providers. For instance, women with diabetes were getting adequate blood sugar monitoring to control their condition. It's possible, though, that there is still less recognition of the need to control cholesterol in women compared with men. Perhaps doctors and women haven't gotten the message that women are at risk of cardiovascular disease and that not managing high cholesterol when you already have a known risk factor like a prior cardiac event or diabetes is going to put you at risk of very poor outcomes from subsequent events. We know that women go to the doctor more than men, and that they tend to get very good medical care relative to men, but in this area they're still lagging behind. We can look at it as an opportunity. We know that women go in to receive care, so we have a chance to change what's happening in those appointments.
Q: What should women do?
A: They need to find out what kind of screening tests they should get annually and what kind of risk factors they need to be controlling.And they need to make sure their doctor is willing to be responsible for overseeing this care, which might mean switching or adding doctors. Many women see gynecologists as their primary care provider, so their care may be more fragmented. If you went to an internist, he or she might be more likely to order a cholesterol screening. It's a lot to ask of
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