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The first large study to examine the impact of insurance status in the treatment and outcomes of men and women with heart attack found that women clearly received fewer cardiac treatments and procedures and had worse outcomes than men, but insurance status did not appear to explain these differences. After adjustment for patient clinical characteristics, hospital characteristics, medications administered within the first 24 hours of admission, and invasive cardiac procedures performed in the hospital, most of the differences in mortality observed among the insurance groups for women and men disappeared, according to the study which was supported in part by the Agency for Healthcare Research and Quality (HS08843).
Regardless of insurance status, women generally were less likely than men to receive aspirin, beta-blockers, intravenous heparin, or nitrate therapies within the first 24 hours of hospital admission. Also, after adjustment for age and race, women were significantly less likely than men to undergo coronary angiography or, after angiography, to undergo either coronary angioplasty or coronary bypass surgery while in the hospital. For every insurance group, women were significantly more likely than men to die in the hospital, with the greatest difference found among women with HMO and commercial insurance.
Women's higher in-hospital death rates were largely attributed to the older age and higher proportion of coexisting medical problems among women (70 percent) than men and to a lesser degree to the fewer medications and invasive cardiac procedures received by women (10 percent). Women's higher short-term risk of death from heart attack compared with men may warrant at least equally aggressive in-hospital assessments and treatments that are known to improve short-term survival, conclude the researchers. Their findings were based on analysis of data on 327,040 men and women enrolled in a national registry of patients who suffered heart attacks from 1994 to 1997.
See "The association of sex and payer status on management and subsequent survival in acute myocardial infarction," by John G. Canto, M.D., M.S.P.H., William J. Rogers, M.D., Nisha C. Chandra, M.D., and others, in the March 11, 2002 Archives of Internal Medicine 162, pp. 587-593.
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