Age and sex differences in the management of ischaemic heart disease.
OBJECTIVE
To investigate age and sex differences in the utilisation of hospital services for ischaemic heart disease.


METHODS
Analysis of routine mortality data and hospital activity data.


METHODS
South West Thames Regional Health Authority.


METHODS
Residents of the South West Thames Regional Health Authority who in 1991 either died from ischaemic heart disease or were admitted to an NHS hospital in England and Wales with a main diagnosis of ischaemic heart disease.


METHODS
Ratio of consultant episodes to deaths from ischaemic heart disease (as a proxy measure of the utilisation of hospital care), and the percentages of consultant episodes in which further investigation (angiography or catheterisation) or revascularisation treatment (coronary artery bypass grafting or angioplasty) were carried out.


RESULTS
The ratio of episodes to deaths was similar in men and women (odds ratio for men vs. women 0.96, 95% confidence intervals 0.90 to 1.03). The percentage of episodes in which further investigation was carried out was higher in men than women (odds ratio for men vs. women 1.46, 95% confidence intervals 1.25 to 1.70) as was the percentage of episodes in which revascularisation treatment was carried out (odds ratio for men vs. women 1.46, 95% confidence intervals 1.20 to 1.77). The ratio of episodes to deaths, the percentage of episodes in which further investigation was carried out, and the percentage of episodes in which revascularisation treatment was carried out all declined with age (all p values < 0.001).


CONCLUSIONS
Women with ischaemic heart disease are as likely as men to be admitted to hospital, but after admission are less likely to undergo further investigation and revascularisation treatment. Elderly patients with ischaemic heart disease are less likely than younger patients to be admitted to hospital; after admission, they are also less likely to undergo further investigation and revascularisation treatment. Further research is needed to determine whether these age and sex differences in the use of hospital services are clinically justified.
Majeed
F A
FA
Department of Public Health Sciences, St. George's Hospital Medical School, London.
Cook
D G
DG
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D004739:England; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000628:therapy*; D010043:Outcome and Process Assessment, Health Care; D010343:Patient Admission / Q000706:statistics & numerical data; D010348:Patient Care Team / Q000706:statistics & numerical data; D012737:Sex Factors; D013222:State Medicine; D016019:Survival Analysis; D014600:Utilization Review; D014852:Wales