Gender bias in cardiovascular testing persists after adjustment for presenting characteristics and cardiac risk
Gender bias in cardiovascular testing persists after adjustment for presenting characteristics and cardiac risk
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DOI：
10.1197/j.aem.2007.03.1355
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发表时间：
2007-07-01
影响因子：
4.4
通讯作者：
Hollander, Judd E.
中科院分区：
文献类型：
--
作者：
Chang, Anna Marie;Mumma, Bryn;Hollander, Judd E.
目的：以前的研究发现，女性患者接受的心血管疾病侵入性检查比男性患者少。作者评估了在急诊科就诊时不同的临床特征是否解释了这种性别差异。方法：前瞻性地确定到一所大学医院就诊的潜在急性冠脉综合征(ACS)患者。一个结构化的数据工具，包括人口统计信息，胸痛描述，病史，体检，胸部X光检查和心电数据完成。医院的疗程每天都被跟踪。患者接受了为期30天的电话随访。结果：纳入研究的女性为3514名(58%)，男性为2547名(42%)。他们有相似的表现特征：胸痛质量(压力/紧张度：女性60%对男性59%，p=0.6)，位置(胸骨下：女性82%对男性80%；p=0.2)，辐射(女性27%对男性26%；p=0.3)，以及大多数相关症状。男性有更多的心脏危险因素(平均1.5vs1.4；p<；0.001)，更多的异常心电图(59%vs.48%，p<；0.001)，以及更高的TIMI风险评分(p<；0.001)。就主要结果而言，男性接受更多的心导管治疗(12.6%比6.0%；优势比[OR]，2.25；95%可信区间[CI]=1.88至2.70)和更多的压力测试(14.7%，比12.3%；比1.22；95%CI=1.05至1.42)。在调整了年龄、种族、心脏危险因素、心电图和TIMI危险评分后，男性仍然接受了更多的心导管检查(调整后的OR为1.72；95%CI=1.40至2.11)和负荷试验(调整后的OR为1.16；95%CI=1.01至1.33)。调整急性心肌梗死或死亡、高危初始临床印象或急诊科配置的模型发现，男性接受导管术的可能性增加，但男女之间的负荷测试没有差异。结论：即使考虑到主诉、病史、心电图和诊断，潜在的急性冠脉综合征患者接受的导管术也比男性患者少。性别偏见不能用临床表现或病程的不同来解释。
Objectives: Previous studies have found that female patients receive fewer invasive tests for cardiovascular disease than male patients. The authors assessed whether different clinical characteristics at emergency department presentation account for this gender bias.Methods: Patients with potential acute coronary syndrome (ACS) who presented to a university hospital were prospectively identified. A structured data instrument that included demographic information, chest pain description, history, physical examination, chest radiography, and electrocardiogram (ECG) data was completed. Hospital course was tracked daily. Patients received 30-day telephone follow-up. The main outcome was whether the patients received objective evaluation for coronary artery disease after adjustment for cardiac risk, including race, age, total number of risk factors, Thrombolysis in Myocardial Infarction (TIMI) score, ECG, and whether the patient sustained an acute myocardial infarction on index hospitalization.Results: There were 3,514 women (58%) and 2,547 men (42%) studied. They had similar presenting characteristics: chest pain quality (pressure/tightness: female 60% vs. male 59%, p = 0.6), location (substernal: female 82% vs. male 80%; p = 0.2), radiation (female 27% vs. male 26%; p = 0.3), and most associated symptoms. Men had more cardiac risk factors (mean 1.5 vs 1.4; p < 0.001), more abnormal ECGs (59% vs. 48%, p < 0.001), and a higher TIMI risk score (p < 0.001). With respect to the main outcome, men received more cardiac catheterizations (12.6% vs. 6.0%; odds ratio [OR], 2.25; 95% confidence interval [CI] = 1.88 to 2.70) and more stress tests (14.7%, vs. 12.3%; OR, 1.22; 95% Cl = 1.05 to 1.42). After adjustment for age, race, cardiac risk factors, ECG, and TIMI risk score, men still received more cardiac catheterizations (adjusted OR, 1.72; 95% Cl = 1.40 to 2.11) and stress tests (adjusted OR, 1.16; 95% Cl = 1.01 to 1.33). Models adjusting for acute myocardial infarction or death, high-risk initial clinical impression, or emergency department disposition found similar results for increased likelihood of cardiac catheterization in men but no difference in stress testing between men and women.Conclusions: Female patients with potential ACS receive fewer cardiac catheterizations than male patients, even when presenting complaint, history, ECG, and diagnosis are taken into account. The gender bias cannot be explained by differences in presentation or clinical course.