title: Sex differences in cardiovascular disease: are women with low socioeconomic status at high risk?
abstract: BACKGROUND
  Cardiovascular disease is still portrayed as a typical male disease, and men are more often submitted to invasive procedures or referred earlier.
  
  
  OBJECTIVE
  To explore sex differences in morbidity and referral patterns in cardiovascular disease in general practice, and the role of age and socioeconomic status.
  
  
  METHODS
  Data were obtained from a continuous morbidity registration project in the Netherlands from 1986 to 1995 in which 12,000 patients were followed over 10 years. The effects of sex, age, and socioeconomic status on morbidity of cardiovascular disease and the referral patterns were established.
  
  
  RESULTS
  The sex difference in morbidity becomes smaller with increasing age. Morbidity was highest in the lower socioeconomic status in general and for angina pectoris in particular. Women with angina pectoris with low socioeconomic status have a relative risk of 2.24 (CI = 1.17-3.26) compared with women with high socioeconomic status. In men, no significant difference was found between the socioeconomic status groups. For angina pectoris the sex difference in referral to the specialist was most significant: 50.6% and 26.6% (P = 0.002) for men and women respectively.
  
  
  CONCLUSIONS
  For women, low socioeconomic status was associated with relatively higher morbidity of angina pectoris and myocardial infarction than for men. Women are less likely to be referred than men are, in particular for angina pectoris.
authors.affiliation: Department of General Practice and Social Medicine, University of Nijmegen, The Netherlands.
authors.forename: E A
authors.initials: EA
authors.lastname: Vogels
authors.forename: A L
authors.initials: AL
authors.lastname: Lagro-Janssen
authors.forename: C
authors.initials: C
authors.lastname: van Weel
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000787:Angina Pectoris / Q000453:epidemiology*; D002318:Cardiovascular Diseases / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D009203:Myocardial Infarction / Q000453:epidemiology*; D009426:Netherlands / Q000453:epidemiology; D012017:Referral and Consultation / Q000639:trends; D012307:Risk Factors; D012737:Sex Factors; D012959:Socioeconomic Factors