Health care disparities in cardiovascular disease: A focus on gender

Abstract

Abstract Heart disease remains the number one killer of women; stroke is number three.1 Despite significantadvances in the diagnosis and treatment of cardiovascular disease (CVD), women remain at risk—in black and Hispanic women, that risk is disproportionately higher than in white women. Awareness of disparities in health care has been stimulated in part by two sweeping reports. The first, “Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care” released by the Institute of Medicine (IOM) in 2002, brought the issue of health care disparities prominently into our national consciousness.2 The second, the “National Healthcare Disparities Report” (NHDR),3 was prepared by the Agency for Healthcare Research and Quality (AHRQ) in response to a mandate from Congress for an annual publication regarding the inconsistencies of health care delivery. The NHDR heightened our awareness of racial, ethnic, and socioeconomic differences in the diagnosis and treatment of various diseases. AHRQ also commissioned the IOM to provide technical guidance on the findings of the NHDR. The IOM guidance document, which was released in 2003, created a construct for our understanding of where, and potentially why, such disparities exist as well as what changes in the health care system are necessary to correct them.3 It would be easy to conclude that lower socioeconomic level and less insurance coverage are themajor causes of the disparities. However, we must recognize that although these are important considerations for ethnic and racial minorities, they are not the only factors. Race and ethnicity themselves significantly influence the type of care received.3 By focusing on the quality of care accessed by and provided to racially, ethnically, socioeconomically, and geographically different populations, the IOM guidance document spotlighted an urgent need to address health care inequities and created a forum for ethical debates on any decision making that would perpetuate such disparities. National attention is also being brought to bear on this issue by the US Department of Health and Human Services through the Healthy People 2010 initiative.4 Finding solutions that would eliminate health care disparities is a key target in creating a healthier population today and in the future. Although eliminating health care disparities in minority populations should remain a focus of this effort, we cannot lose sight of gender-based disparities, especially as they relate to the diagnosis and treatment of CVD.