Gender disparities in stress test utilization in chest pain unit patients based upon the ordering physician's gender.

Abstract

Physicians' gender may impact test utilization in the diagnosis of acute cardiovascular disease. We sought to determine if physician gender affected stress test utilization by patient gender in a low-risk chest pain observation unit. This was a retrospective consecutive cohort study of patients admitted to a chest pain unit in a large volume academic urban emergency department (ED). Inclusion criteria were age>18, American Heart Association low-to-intermediate risk, electrocardiogram nondiagnostic for acute coronary syndrome, and negative initial troponin I. Exclusion criteria were age>75 with a history of coronary artery disease, active comorbid medical problems, or inability to obtain stress testing in the ED for any reason. T-tests were used for univariate comparisons and logistic regression was used to estimate odds ratios (ORs) for receiving testing based on physician gender, controlling for race, insurance, and Thrombolysis In Myocardial Infarction (TIMI) score. Three thousand eight hundred and seventy-three index visits were enrolled during a 2.5-year period. Mean age was 53±20, 55% (95% CI, 53-56%) were female. There was no difference in overall stress utilization based upon physician gender (P=0.28). However, after controlling for other variables, male physicians had significantly lower odds of stress testing female patients (ORM, 0.82; 95% CI, 0.68-0.99), whereas no difference was found in female physicians (ORF, 0.80; 95% CI, 0.57-1.14). Male physicians appear less likely to utilize stress testing in female patients even after controlling for objective clinical variables, including TIMI score. Although adverse outcomes are uncommon in this patient cohort, further investigation into provider-specific practice patterns based on patient gender is necessary.