title: Relation of gender and health insurance to cardiovascular procedure use in persons with progression of chronic renal disease.
abstract: BACKGROUND
  Women often are less likely than men to receive diagnostic and therapeutic invasive procedures for coronary disease.
  
  
  OBJECTIVE
  To examine the relation between gender, health insurance, and access to cardiovascular procedures over time in persons with chronic illness.
  
  
  METHODS
  Seven-year longitudinal analyses in a cohort from the United States Renal Data System.
  
  
  METHODS
  National random sample of women and men who progressed to end-stage renal disease (ESRD) in 1986 to 1987 and were treated at 303 dialysis facilities (n = 4,987).
  
  
  METHODS
  Medical history and utilization records, physical examination, and laboratory data.
  
  
  METHODS
  Receipt of a coronary catheterization or revascularization procedure before (baseline) and after (follow-up) the development of ESRD and acquisition of Medicare, adjusted for clinical and socioeconomic variables.
  
  
  RESULTS
  At baseline, 5.2% of women and 9.2% of men had undergone a cardiac procedure; the odds of women receiving a procedure were one third lower than for men (adjusted odds ratio 0.66 [95% CI 0.49-0.88]). During follow-up, women were just as likely as men to undergo a procedure (adjusted odds ratio 0.94 [95% CI 0.74-1.20]). Compared with men with baseline private insurance, men and women with other and no insurance had 34% to 81% lower odds of receiving procedures at baseline. Women with private insurance had 42% lower odds of having a procedure at baseline compared with men (adjusted odds ratio 0.58 [95% CI 0.42-0.78]) but had the same odds at follow-up (adjusted odds ratio 1.09 [95% CI 0.82-1.45]). At follow-up, gender differences in procedure use were eliminated for groups with baseline Medicaid or no insurance.
  
  
  CONCLUSIONS
  Overall gender differences in cardiac procedure use were narrowed markedly after progression of a serious illness, the assurance of health insurance, and entry into a comprehensive care system. Gender disparities in procedure use for different baseline insurance groups were largely equalized in follow-up. These findings suggest that provision of insurance with disease-managed care for a chronic disease can provide equalized access to care for women.
authors.affiliation: Robert Wood Johnson Clinical Scholars Program, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. gdaumit@jhmi.edu
authors.forename: G L
authors.initials: GL
authors.lastname: Daumit
authors.forename: J A
authors.initials: JA
authors.lastname: Hermann
authors.forename: N R
authors.initials: NR
authors.lastname: Powe
mesh_terms: D000328:Adult; D000368:Aged; D006328:Cardiac Catheterization / Q000706:statistics & numerical data; D015331:Cohort Studies; D003327:Coronary Disease / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D019458:Insurance Coverage / Q000706:statistics & numerical data*; D007676:Kidney Failure, Chronic / Q000453:epidemiology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization / Q000706:statistics & numerical data*; D012737:Sex Factors; D014481:United States / Q000453:epidemiology; D014600:Utilization Review; D014932:Women's Health Services / Q000706:statistics & numerical data*