Differences between men's and women's treatment and outcomes after heart attacks may have more to do with age than gender, suggests a new study published in the June 19, 2002, issue of the Journal of the American College of Cardiology.
"Women tend to have heart attacks much later in life than men," said lead author Dr. David A. Alter of the Institute for Clinical Evaluative Sciences in Toronto, Ontario, Canada. "Our study found that differences in the treatment offered to men and women after heart attacks are driven more by differences in age than by differences in gender per se. There certainly doesn't appear to be any gender discrimination."
Although previous studies have focused on possible gender bias in the delivery of specialized cardiac care, these studies have typically focused on overall gender differences without examining gender differences at various ages. To fill that research gap, Dr. Alter and his colleagues turned to administrative data from 25,697 heart attack patients hospitalized in Ontario between April 1992 and December 1993. They then examined the association of age and gender with treatment intensity and five-year survival. After adjusting for baseline differences, the researchers found that the rate of angiography -- an invasive imaging technique -- fell 17.5 percent for women relative to men with every 10-year increase in age. The rate of follow-up specialty care for women relative to men fell 10.2 percent with every 10-year increase.
But while care became progressively less aggressive for women the older they got, their long-term survival rates relative to men actually improved. In fact, relative survival in women rose 14.2 percent for every 10-year increase in age. For Dr. Alter, these results suggest that age bias -- not gender bias -- may be the real problem.
"Our findings suggest that current perceptions about the risks and benefits of providing treatment as patients age may be resulting in undertreatment of the elderly," said Dr. Alter. "Given that the elderly have the highest risk of poor outcomes without treatment, the number of individuals who could benefit from specialized care would be greatest among this growing segment of the population."