DIFFERENCES IN THE USE OF PROCEDURES BETWEEN WOMEN AND MEN HOSPITALIZED FOR CORONARY HEART-DISEASE
DIFFERENCES IN THE USE OF PROCEDURES BETWEEN WOMEN AND MEN HOSPITALIZED FOR CORONARY HEART-DISEASE
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DOI：
10.1056/nejm199107253250401
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发表时间：
1991-07-25
影响因子：
158.5
通讯作者：
EPSTEIN, AM
中科院分区：
文献类型：
--
作者：
AYANIAN, JZ;EPSTEIN, AM
背景和方法。以前在个别医院进行的研究报告了女性和男性冠心病患者在使用主要诊断和治疗程序方面的差异。为了评估这些差异是否可以推广，我们对1987年因冠心病住院的女性和男性进行了冠状动脉造影和血运重建（冠状动脉旁路手术或经皮腔内冠状动脉成形术）的回顾性分析，使用了马萨诸塞州49,623例出院和马里兰州33,159例出院的抽象数据。我们使用多元逻辑回归来估计使用手术的调整几率，控制主要诊断、年龄、充血性心力衰竭或糖尿病的次要诊断、种族和保险状况。在马萨诸塞州和马里兰州，男性接受血管造影术的调整后比值分别比女性高28%和15%（比值比的95%置信区间为1.22至1.35和1.08至1.22）。男性接受血运重建的调整后几率分别比女性高45%和27%（95%置信区间，1.35至1.55和1.16至1.40）。由于这些差异可能与不同的入院阈值有关，我们进行了第二次分析，仅限于诊断为急性心肌梗死的患者（马萨诸塞州有11，865例出院，马里兰州有6894例出院），所有患者都将接受医院护理。两种状态下的男性与女性比值比在大小上保持相似，并且在血管造影和血运重建方面具有统计学意义。这些研究结果表明，因冠心病住院的妇女比男子接受较少的主要诊断和治疗程序。这些差异可能代表了男性和女性的适当护理水平，但也可能反映了女性使用不足或男性过度使用。进一步的研究应该评估这些差异的原因及其对患者结局的影响。
Background and Methods. Previous studies at individual hospitals have reported differences in the use of major diagnostic and therapeutic procedures for women and men with coronary heart disease. To assess whether these differences can be generalized, we performed retrospective analyses of coronary angiography and revascularization (coronary-artery bypass surgery or percutaneous transluminal coronary angioplasty) in women and men hospitalized for coronary heart disease in 1987, using abstract data on 49,623 discharges in Massachusetts and 33,159 discharges in Maryland. We used multiple logistic regression to estimate the adjusted odds of the use of a procedure, controlling for principal diagnosis, age, secondary diagnosis of congestive heart failure or diabetes mellitus, race, and insurance status.Results. The adjusted odds of undergoing angiography were 28 percent and 15 percent higher for men than for women in Massachusetts and Maryland, respectively (95 percent confidence intervals for the odds ratios, 1.22 to 1.35 and 1.08 to 1.22). The respective adjusted odds of undergoing revascularization were 45 percent and 27 percent higher for men than for women (95 percent confidence intervals, 1.35 to 1.55 and 1.16 to 1.40). Because these differences could be related to differing thresholds for hospital admission, we performed a second analysis limited to patients with diagnosed acute myocardial infarction (11,865 discharges in Massachusetts and 6894 discharges in Maryland), a group in which all patients would be expected to receive hospital care. The male-to-female odds ratios in both states remained similar in magnitude and were statistically significant for angiography and revascularization.Conclusions. These findings demonstrate that women who are hospitalized for coronary heart disease undergo fewer major diagnostic and therapeutic procedures than men. These differences may represent appropriate levels of care for men and women, but it is also possible that they reflect underuse in women or overuse in men. Further study should assess the cause of these differences and their effect on patients' outcomes.