Medical Decision Making, Gender, and Coronary Heart Disease

Abstract

In order to assess possible gender bias in the diagnosis and treatment of heart disease, data from the National Hospital Discharge Survey (NHDS) for the years 1983–1989 were examined for gender differences and for variations among four major geographic areas of the United States (northeast, midwest, south, and west). Dramatic increases in the rates of diagnostic procedures and surgical treatments were found. Analyses of covariance additionally revealed significant regional differences in rates of procedures, with rates for the midwest generally high and those in the south and northeast generally low for angiocardiography (p <.0001), cardiac catheterization (p <.0001), angioplasty (p <.0001), and bypass (p <.0001). These differences were largely independent of disease epidemiology and suggest that practice variations may be shaped by considerations not strictly based on medical diagnoses. Analysis of covariance also revealed significant gender differences, with rates consistently higher among men for angiocardiography (p <.0001), catheterization (p <.0001), angioplasty (p <.001), and in bypass (p <.0001). On average, gender accounted for approximately 25% of the variance in rates of diagnosis and treatment. This suggests that gender may be a factor in decision making. The question of whether these results represent o ver utilization of services for men or underutilization of services for women is posed.