Sex differences in use of interventional cardiology persist after risk adjustment.
BACKGROUND
Studies from several countries have documented gender disparities in the management of coronary artery disease. Whether such gender disparities are seen in Italy and, if so, whether they can be explained by factors such as age and severity of illness were investigated.


METHODS
77 974 Piedmontese patients, admitted between 1999 and 2002, with a primary diagnosis of myocardial infarction (ICD 410), angina (ICD 413), chronic ischaemia (ICD 414) and chest pain (ICD 786.5) were studied. The number of men and women undergoing surgical treatment was extracted and the male-female odds ratios calculated. Several risk factors and a risk adjustment technique (APR-DRG) were used to control for possible confounders. Backward stepwise multiple logistic regression was used to adjust for significant covariates.


RESULTS
Crude analysis demonstrated that gender is a discriminating factor in the probability of surgery (OR 2.11, 95% CI 2.04 to 2.19), with similar findings among those with each main diagnosis. The odds ratios decreased after adjustment for age, co-morbidity and disease severity but remained significant.


CONCLUSIONS
Men and women admitted to hospitals in a region of northern Italy with a diagnosis of cardiovascular disease are treated differently and this cannot be explained by age or severity of disease.
Nante
N
N
Health Services Research Laboratory, University of Sienna, Sienna, Italy. nante@unisi.it
Messina
G
G
Cecchini
M
M
Bertetto
O
O
Moirano
F
F
McKee
M
M
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003925:Diabetic Angiopathies / Q000453:epidemiology / Q000628:therapy; D004812:Epidemiologic Methods; D005260:Female; D015276:Health Care Rationing / Q000706:statistics & numerical data; D006333:Heart Failure / Q000150:complications / Q000453:epidemiology; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007558:Italy / Q000453:epidemiology; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000453:epidemiology / Q000601:surgery / Q000628:therapy*; D009204:Myocardial Revascularization / Q000379:methods / Q000706:statistics & numerical data*; D011287:Prejudice; D020379:Risk Adjustment / Q000379:methods; D012737:Sex Factors