Gender disparities in lipid management: the presence of disparities depends on the quality measure.
OBJECTIVE
To determine if the use of a more detailed quality measure affected the finding of gender disparities in lipid management.


METHODS
Retrospective cohort study.


METHODS
Study subjects included 2589 patients with diabetes mellitus in a managed care plan in 2000-2001. We compared the quality of lipid management in men and women using the following 3 measures: (1) the traditional screening measure (measurement of low-density lipoprotein cholesterol [LDL-C] level), (2) the LDL-C level (ie, among those with an LDL-C level measured, an LDL-C level < 130 mg/dL [< 3.37 mmol/L]), and (3) a more detailed appropriate management measure (an LDL-C level < 130 mg/dL or an LDL-C level >or= 130 mg/dL plus statin initiation or intensification). Multivariate models were adjusted for clustering within clinic and for patient age, insulin use, hypertension, ischemic heart disease, cerebrovascular disease, congestive heart failure, and number of visits.


RESULTS
In unadjusted analyses, using the traditional screening measure, women were less likely to be screened than men (P < .001). Using the LDL-C measure, women were less likely to have an LDL-C level less than 130 mg/dL (P = .047). However, using the appropriate management measure, women were as likely to receive appropriate management as men once their lipid levels were measured (P = .08).


CONCLUSIONS
Quality measures that only examine LDL-C screening or LDL-C levels may demonstrate that women receive poorer lipid management than men among patients with diabetes mellitus. However, this gender disparity does not persist with the use of a more detailed measure.
Kim
Catherine
C
Division of General Medicine, Department of Internal Medicine, University of Michigan Medical School, 300 North Ingalls Building, Room 7C13, Ann Arbor, MI 48109-0429, USA. cathkim@umich.edu
Kerr
Eve A
EA
Bernstein
Steven J
SJ
Krein
Sarah L
SL
D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D006801:Humans; D006949:Hyperlipidemias / Q000188:drug therapy; D008055:Lipids / Q000032:analysis* / Q000097:blood; D008297:Male; D008403:Mass Screening / Q000592:standards*; D008875:Middle Aged; D012189:Retrospective Studies; D012737:Sex Factors
D008055:Lipids