Disparities in utilization of coronary artery disease treatment by gender, race, and ethnicity: opportunities for prevention.
Racial, ethnic, (R/E) and gender disparities in access to health services in the United States and their relationship to adverse health outcomes are well established. Despite an increase in evidence-based cardiovascular treatment, gender, racial, and ethnic disparities in coronary artery disease (CAD) treatment persist. There is neither currently a comprehensive framework for understanding why disparities occur in cardiovascular disease care, nor viable solutions for intervention. This article synthesizes the literature on disparities in coronary artery disease with a conceptual model for understanding chronic disease disparities. This article follows the natural history of disease to observe where differences arise, beginning with health risk management, screening, diagnosis, treatment, and rehabilitation. Racial, ethnic, and gender differences were found at every step of this continuum, including a higher burden of risk factors and a less likelihood of receiving needed lifesaving cardiac procedures. Unfortunately, there is a dearth of intervention strategies to reduce racial, ethnic, and gender disparities in coronary artery disease. Comprehensive solutions will require addressing the barriers at the system, the provider, and the patient level. An early intervention approach that addresses multiple risk factors should be a high priority.
Schneider Institutes for Health Policy, The Heller School, Brandeis University, Waltham, MA 02454-9110, USA. Bhalotra@Brandeis.edu
Sarita
S
Bhalotra
Mathilda B M
MB
Ruwe
Gail K
GK
Strickler
Andrew M
AM
Ryan
Clare L
CL
Hurley
D001741:Black or African American / Q000208:ethnology / Q000706:statistics & numerical data; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D006348:Cardiac Surgical Procedures / Q000706:statistics & numerical data*; D002309:Cardiology / Q000706:statistics & numerical data*; D002423:Cause of Death; D015897:Comorbidity; D003324:Coronary Artery Disease / Q000208:ethnology / Q000628:therapy; D003935:Diagnostic Techniques, Cardiovascular / Q000706:statistics & numerical data*; D005260:Female; D005783:Gender Identity; D006302:Health Services Research; D006630:Hispanic or Latino / Q000208:ethnology / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011322:Primary Prevention; D012307:Risk Factors; D017678:Sex Distribution; D014481:United States / Q000453:epidemiology; D044465:White People / Q000208:ethnology / Q000706:statistics & numerical data