title: A community-wide perspective of gender differences and temporal trends in the use of diagnostic and revascularization procedures for acute myocardial infarction.
abstract: This study compares the overall use, as well as temporal trends, of various diagnostic and revascularization procedures for acute myocardial infarction (AMI) in men and women. The study sample comprised a total of 2,924 men and 1,838 women with validated AMI admitted to any of the 16 teaching and community hospitals in the Worcester, Massachusetts, metropolitan area during 1975, 1978, 1981, 1984, 1986 and 1988. During the period under study there was a significant increase in use of each of the examined procedures during hospitalization for AMI in both men and women. Increasing use of multiple procedures was also seen for each of the sexes. After controlling for a variety of demographic and clinical factors that might affect utilization rates, men were marginally more likely to undergo radionuclide ventriculography, and significantly more likely to undergo Holter monitoring, exercise treadmill testing, cardiac catheterization, and percutaneous transluminal coronary angioplasty than women. However, there were no gender differences in the use of coronary artery bypass grafting. On the other hand, men were significantly less likely to undergo echocardiography. The results of this multihospital, population-based study suggest sex differences in the use of several diagnostic and revascularization procedures during hospitalization for AMI. These differences may be attributed to physicians' practice patterns, although gender bias in the delivery of medical care cannot be excluded. Temporal trends in increased overall use of these procedures raise questions about cost-effectiveness that need to be further addressed.
authors.affiliation: Department of Medicine, University of Massachusetts Medical School, Worcester 01655.
authors.forename: D E
authors.initials: DE
authors.lastname: Chiriboga
authors.forename: J
authors.initials: J
authors.lastname: Yarzebski
authors.forename: R J
authors.initials: RJ
authors.lastname: Goldberg
authors.forename: Z
authors.initials: Z
authors.lastname: Chen
authors.forename: J
authors.initials: J
authors.lastname: Gurwitz
authors.forename: J M
authors.initials: JM
authors.lastname: Gore
authors.forename: J S
authors.initials: JS
authors.lastname: Alpert
authors.forename: J E
authors.initials: JE
authors.lastname: Dalen
mesh_terms: D000367:Age Factors; D000368:Aged; D016009:Chi-Square Distribution; D005260:Female; D006297:Health Services Accessibility; D006334:Heart Function Tests / Q000706:statistics & numerical data; D006769:Hospitals, General / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D008297:Male; D008404:Massachusetts / Q000453:epidemiology; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000453:epidemiology / Q000401:mortality / Q000601:surgery; D009204:Myocardial Revascularization / Q000706:statistics & numerical data*; D011287:Prejudice; D012737:Sex Factors; D013997:Time Factors