Race and sex differences in the management of coronary artery disease.
Race and sex differences in the management of coronary artery disease.
复制标题
冠状动脉疾病治疗中的种族和性别差异。
DOI：
10.1016/s0002-8703(00)90017-6
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发表时间：
2000
影响因子：
4.8
通讯作者：
Schulman,KA
中科院分区：
文献类型：
--
作者：
Sheifer,SE;Escarce,JJ;Schulman,KA
尽管许多研究已经证明了冠状动脉疾病治疗中的种族和性别差异，但现有的分析尚未得到全面评价。在这篇综述中，我们总结了以前的估计种族和性别差异的标准测试和治疗的利用，我们评估的因素，可能有助于护理差距的研究。这些研究一致表明，与白人和男性相比，患有冠状动脉疾病的黑人和女性接受标准干预的可能性大大降低。研究还表明，种族差异部分与社会经济因素，护理过程变量和患者偏好有关，而性别差异部分与临床因素有关。然而，在这两种情况下，我们的理解受到现有数据集缺陷的限制。此外，已被证明造成医疗保健方面种族和性别差异的因素未能充分解释这些差异。在这两种情况下，医生的决策似乎也有贡献，这表明潜意识的偏见可能会导致治疗差异。最后，我们提出了一些倡议，以纠正医疗保健中的种族和性别差异。应努力提高医生对这一问题的认识。研究应收集目前无法用于分析的数据，包括详细的临床变量和患者水平的社会经济信息。最后，新的质量保证计划，旨在评估和改善黑人和妇女冠状动脉疾病的护理，应及时进行。
Although numerous studies have documented race and sex differences in the treatment of coronary artery disease, the available analyses have not been comprehensively evaluated. In this review, we summarize prior estimates of race and sex disparities in the utilization of standard tests and therapies, and we evaluate studies of factors that may contribute to gaps in care. The studies presented consistently demonstrate that blacks and women with coronary artery disease, compared with whites and men, are substantially less likely to receive standard interventions. Studies also indicate that racial differences relate in part to socioeconomic factors, process-of-care variables, and patient preferences, whereas sex differences relate in part to clinical factors. In both cases, however, our understanding is limited by deficiencies in currently available datasets. Moreover, factors that have been shown to contribute to race and sex disparities in medical care fail to explain them fully. In both cases, physician decision-making appears to contribute as well, suggesting that subconscious biases may contribute to treatment disparities. We conclude by proposing initiatives to remedy race and sex disparities in medical care. Efforts should focus on increasing physician awareness of this problem. Studies should gather data that are currently unavailable for analysis, including detailed clinical variables and patient-level socioeconomic information. Finally, novel quality assurance programs, designed to evaluate and improve the care of blacks and women with coronary artery disease, should be promptly undertaken.