Gender Disparities in the Treatment of Coronary Artery Disease For Older Persons: A Comparative Analysis of National and City-Level Data

Background: Gender disparities in the treatment of coronary artery disease (CAD) have been extensively documented in studies from the United States. However, they have been less well studied in other countries and, to our knowledge, have not been investigated at the more disaggregated spatial level of cities.

Objective: This study tests the hypothesis that there is a common international pattern of gender disparity in the treatment of CAD in persons aged ≥65 years by analyzing data from the United States, France, and England and from their largest cities-New York City and its outer boroughs, Paris and its First Ring, and Greater London.

Methods: This was an ecological study based on a retrospective analysis of comparable administrative
data from government health databases for the 9 spatial units of analysis: the 3 countries, their 3 largest
cities, and the urban cores of these 3 cities. A simple index was used to assess the relationship between
treatment rates and a measure of CAD prevalence by gender among age-adjusted cohorts of patients.
Differences in rates were examined by univariate analysis using the Student t test for statistical differences
in mean values.

Results: Despite differences in health system characteristics, including health insurance coverage, availability
of medical resources, and medical culture, we found consistent gender differences in rates of percutaneous
transluminal coronary angioplasty and coronary artery bypass grafting across the 9 spatial units.
The rate of interventional treatment in women with CAD was less than half that in men. This difference
persisted after adjustment for the prevalence of heart disease.

Conclusions: A consistent pattern of gender disparity in the interventional treatment of CAD was seen
across 3 national health systems with known differences in patterns of medical practice. This finding is
consistent with the results of clinical studies suggesting that gender disparities in the treatment of CAD
are due at least in part to the underdiagnosis of CAD in women.