REFERRAL PATTERNS FOR CORONARY-ARTERY DISEASE TREATMENT - GENDER BIAS OR GOOD CLINICAL JUDGMENT
REFERRAL PATTERNS FOR CORONARY-ARTERY DISEASE TREATMENT - GENDER BIAS OR GOOD CLINICAL JUDGMENT
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DOI：
10.7326/0003-4819-116-10-791
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发表时间：
1992-05-15
影响因子：
39.2
通讯作者：
CALIFF, RM
中科院分区：
文献类型：
--
作者：
BICKELL, NA;PIEPER, KS;CALIFF, RM
目的：研究冠状动脉旁路移植术患者中是否存在性别偏见。设计：历史队列研究(1969-1984)。地点：转诊医学中心。患者：总计5795名经导管检查证实的冠心病患者。测量：按心脏死亡风险和治疗效果分组的男性和女性的手术转诊模式。评估了三个时期的时间趋势：1969-1974年，1975-1979年，1980-1984年。结果：总体而言，在没有调整心源性死亡基线风险的情况下，男性和女性之间在转诊手术方面没有发现统计学差异(46%比44%)。在对这种风险进行调整后，在心脏病死亡风险较低的患者中，手术转诊的男性与女性的优势比为1.28(95%CI，1.05至1.58)。这种影响在1980-1984年期间最为明显(优势比为1.73；CI为1.29-2.31)。在高危人群中，优势比为0.84(CI，0.68至1.04)，在研究过程中几乎没有变化。与药物治疗相比，当手术提供的生存益处最小时，男性更有可能被转介接受手术(优势比为1.29；CI为1.08至1.54)。这种影响在1980-1984年间最为明显(优势比为1.63；CI为1.27-2.10)。结论：在心脏死亡风险较低的患者中，女性比男性更不可能接受冠状动脉旁路移植手术，在这些患者中，手术几乎没有或没有提供比内科治疗更多的生存益处。在有症状和病情更严重的患者中，女性至少与男性一样有可能被转介接受搭桥手术，在这些患者中，手术提供了最大的生存益处。这些趋势在最近几年的研究中最为突出。根据手术存活率的好处，这些转诊模式可能比男性更适合女性的治疗转诊。
Objective: To determine whether a gender bias exists in referral for coronary bypass graft surgery among patients with catheterization-documented coronary artery disease.Design: Historical cohort study (1969 to 1984).Setting: A referral medical center.Patients: A total of 5795 patients with catheterization-documented coronary artery disease.Measurements: Surgical referral patterns of men and women grouped by risk for cardiac death and by treatment effectiveness. Time trends were evaluated for three periods: 1969 to 1974, 1975 to 1979, and 1980 to 1984.Results: Overall, when no adjustment was made for baseline risk for cardiac death, no statistical difference was found between men and women regarding referral for surgery (46% compared with 44%, respectively). When an adjustment was made for such risk, the male-to-female odds ratio for surgical referral was 1.28 (95% Cl, 1.05 to 1.58) among patients with a low risk for cardiac death. This effect was most evident in the 1980 to 1984 period (odds ratio, 1.73; Cl, 1.29 to 2.31). In the high-risk group, the odds ratio was 0.84 (Cl, 0.68 to 1.04), with little change occurring during the study. Men were more likely to be referred for surgery when surgery offered the least survival benefit relative to medical therapy (odds ratio, 1.29; Cl, 1.08 to 1.54). This effect was most pronounced in the 1980 to 1984 period (odds ratio, 1.63; Cl, 1.27 to 2.10).Conclusions: Women are less likely than men to be referred for coronary bypass graft surgery among patients with a low risk for cardiac death, in whom surgery offers little or no survival benefit over medical treatment. Women are at least as likely as men to be referred for bypass surgery among more symptomatic and more severely diseased patients, in whom surgery offers the greatest survival benefits. These trends were most prominent in the recent years of the study. Based on surgical survival benefits, these referral patterns may represent more appropriate treatment referral for women than men.