Gender bias in the clinical management of women with angina: another look at the Yentl syndrome.
BACKGROUND
Woman with heart disease may receive lower levels of clinical care than men. We assessed whether the Yentl syndrome (women receive equivalent care to men only when they demonstrate that they are like men by having a heart attack) operates in the management of angina pectoris in primary care.


METHODS
The study design is a cross-sectional survey of 1162 angina patients (552 women) managed in eight sentinel centers serving 15% of the population of Liverpool. Data were extracted by specially trained data managers. Analysis included directly age-standardized proportions and male/female adjusted odds ratios (AOR), adjusted for age, disease duration, physician consultation rate, and age at diagnosis.


RESULTS
All aspects of care were higher for men with angina-previous myocardial infarction (MI) than for women with angina-previous MI. Risk factor recording was an absolute 8% higher (95% CI 1%-17%), secondary prevention 9% higher (95% CI 1%-17%), cardiac investigation 10% higher (95% CI 1%-20%), and revascularization 13% higher (95% CI 4%-22%). Men with angina-previous MI consistently received the highest level and women with angina the lowest level of risk factor recording (AOR 1.79, 95% CI 1.21-2.66), secondary prevention (AOR 2.24, 95% CI 1.47-3.40), cardiac investigation (AOR 2.21, 95% CI 1.56-3.13), and revascularization (AOR 4.67, 95% CI 3.03-7.18). The provision of care to men with angina alone and women with angina-previous MI fell between these two extremes.


CONCLUSIONS
A gender-based clinical hierarchy operates in the clinical management of angina pectoris in primary care. The Yentl syndrome did not apply, however, as women with angina received less intensive clinical care than similar men irrespective of prior MI.
Crilly
Michael A
MA
Department of Public Health, University of Aberdeen Medical School, Aberdeen, AB25 2ZD, U.K. mike.crilly@abdn.ac.uk
Bundred
Peter E
PE
Leckey
Lisa C
LC
Johnstone
Fiona C
FC
D000368:Aged; D000369:Aged, 80 and over; D000787:Angina Pectoris / Q000453:epidemiology* / Q000628:therapy*; D016001:Confidence Intervals; D017023:Coronary Angiography / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D005260:Female; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011287:Prejudice; D011320:Primary Health Care / Q000706:statistics & numerical data*; D017678:Sex Distribution; D016896:Treatment Outcome; D006113:United Kingdom / Q000453:epidemiology; D016387:Women's Health