Age and sex differences in the management of ischaemic heart disease

Majeed, Azeem; Cook, Derek G

doi:10.1016/s0033-3506(96)80027-8

Cited by 30 publications

(19 citation statements)

References 28 publications

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“…More recently, in Scotland, routine hospital admission data have demonstrated that socioeconomic deprivation and female gender3 are associated with relatively low rates of angiography and coronary artery bypass grafting. Another study based on routine data showed no gender difference in access to hospital, but after admission, men were more likely to receive cardiological investigations and treatment 4. This gender variation was confirmed in a large cross sectional study5 in which, after controlling for disease severity and comorbidity, it was found that women with coronary heart disease were less likely than men to undergo cardiac surgery.…”

mentioning

confidence: 87%

Social and gender variation in the prevalence, presentation and general practitioner provisional diagnosis of chest pain

Richards

McConnachie²,

Morrison³

et al. 2000

Journal of Epidemiology &Amp; Community Health

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Objectives-To describe the prevalence of Rose angina and non-exertional chest pain in men and women in socioeconomically contrasting areas; to describe the proportions of men and women who present with the symptom of chest pain and who receive a provisional general practitioner diagnosis of coronary heart disease; to assess the eVects of gender and deprivation. Design-Two random general population samples in socially contrasting areas were surveyed using the Rose angina questionnaire: the case notes of people identified with chest pain were reviewed. Setting-Glasgow conurbation. Participants-1107 men and women, aged 45-64, with chest pain. Outcome measures-Prevalence of Rose angina and non-exertional chest pain; the proportions who had presented with chest pain and received a general practitioner's provisional diagnosis of coronary heart disease. Results-There was no diVerence between social groups in the prevalence of all chest pain but a greater proportion of those in deprived groups had Rose angina and a greater proportion of these had the more severe grade. The proportion of people who had presented with chest pain was higher among socioeconomically deprived groups but there was no diVerence in the proportions receiving a general practitioner provisional diagnosis of coronary heart disease. Men were more likely to present with chest pain than women and were more likely to receive a provisional general practitioner diagnosis of coronary heart disease. Research in the United Kingdom shows that rates of uptake of coronary angiography and cardiac surgery are not commensurate with need, as measured by coronary heart disease prevalence 1 or mortality. 2 A study based on coronary heart disease prevalence 1 showed that patients in aZuent areas with Rose angina were more likely to undergo coronary revascularisation than those in socially deprived areas. A Glasgow study that used mortality as a proxy for need demonstrated a relative excess of coronary angiography in patients from more aZuent areas (Kesson E, personal communication). More recently, in Scotland, routine hospital admission data have demonstrated that socioeconomic deprivation and female gender 3 are associated with relatively low rates of angiography and coronary artery bypass grafting. Another study based on routine data showed no gender diVerence in access to hospital, but after admission, men were more likely to receive cardiological investigations and treatment. 4 This gender variation was confirmed in a large cross sectional study 5 in which, after controlling for disease severity and comorbidity, it was found that women with coronary heart disease were less likely than men to undergo cardiac surgery. Conclusions-NoMost studies reporting variations in access to hospital services have focused on processes occurring in secondary care. It is unclear whether such variations arise from decisions made by hospital doctors, general practitioners or patients. One exception was a study based on self report by angina patients of general practitioner re...

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confidence: 87%

Social and gender variation in the prevalence, presentation and general practitioner provisional diagnosis of chest pain

Richards

McConnachie²,

Morrison³

et al. 2000

Journal of Epidemiology &Amp; Community Health

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“…A review is provided in [9]. Examples are Ben-Shlomo and Chaturvedi [10] who use routine hospital inpatient episode data (HES data) to study access to coronary artery bypass graft operations in different health regions in London, and Majeed and Cook [11] and Payne and Saul [12] who used individual level data to review access to revascularisation surgery in different parts of the UK. Using HES data Chaturvedi and Ben-Shlomo [13] found marked differences in operative rates across local areas (wards) in the North East Thames Region for cataract and tonsil operations and a strong association with increasing area deprivation for varicose vein operations.…”

Section: Income and The Use Of Uk Health Carementioning

confidence: 99%

Access to health care resources in the UK: the case of care for arthritis

et al. 2005

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The paper uses new and detailed data from a population sample of individuals with arthritis to examine the impact of objective measures of need for treatment and individual measures of socio-economic position on the distribution of public and private health care. The quality of the data and the range of explanatory factors are more detailed than previously used to study of the allocation of NHS care. The results indicate that broadly the NHS appears to meet its equity goal of equal care for equal medical need, though there is evidence that education increases the amount of resources received. The results also show the importance of the interaction between the public and private sectors in the UK.

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“…1 Most research has concerned racial or ethnic and economic disparities, 2,3 whereas age-related disparities have received less attention. Some evidence does suggest there are age-related disparities disfavoring the elderly in health care access, 4,5 provider-patient communication, [6][7][8] and the delivery of certain diagnostic 7,9-13 and therapeutic 5,7,9,10,[14][15][16][17][18] interventions, and may contribute to poorer treatment outcomes. 19 Because older adults constitute a large and rapidly growing subpopulation, 20 age-related disparities in health care merit increased attention.…”

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confidence: 99%

Age-Related Disparities in Cancer Screening: Analysis of 2001 Behavioral Risk Factor Surveillance System Data

Jerant

Franks

Jackson

et al. 2004

The Annals of Family Medicine

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PURPOSE Although few studies have explored age-related health care disparities, some researchers have asserted such disparities uniformly disfavor the elderly and are largely attributable to ageism in the health care system. We compared agerelated patterns of screening for colorectal cancer with those for breast and prostate cancer in persons aged 50 years and older. METHODSWe analyzed data for all adults aged 50 years and older (N = 88,213) in the 2001 Behavioral Risk Factor Surveillance System (BRFSS), a nationally representative, telephone-administered survey of personal health behaviors. Main outcome measures were adjusted prevalence by 5-year age-groups of colorectal cancer screening using fecal occult blood testing, fl exible sigmoidoscopy, or colonoscopy for men and women; rates of mammography screening for women; and rates of prostate-specifi c antigen (PSA) screening for men. RESULTSAfter adjustment for race/ethnicity, education level, income, health insurance, and self-rated health, predicted reported colorectal cancer screening (all modalities) increased signifi cantly from when patients reached age 50 years until 70 to 74 years (66.0%, standard error [SE] 0.8%), remained constant until age 80 years, and then declined. The age-related gain in colorectal cancer screening was confi ned to whites among patients older than 60 years. Reported PSA screening increased until age 75 to 79 years (79.3%, SE 1.1%) and then declined, whereas reported mammography screening peaked at age 55 to 59 years (83.3%, SE 1.2%) and then declined.CONCLUSIONS Signifi cant age-related disparities appear to exist for both evidence-based and non-evidence-based cancer-screening interventions. The issue of age-related disparities in cancer screening is complex, with the direction of disparity favoring the elderly for some services yet disfavoring them for others. 1 Most research has concerned racial or ethnic and economic disparities, 2,3 whereas age-related disparities have received less attention. Some evidence does suggest there are age-related disparities disfavoring the elderly in health care access, 4,5 provider-patient communication, 6-8 and the delivery of certain diagnostic 7,9-13 and therapeutic 5,7,9,10,[14][15][16][17][18] interventions, and may contribute to poorer treatment outcomes. 19 Because older adults constitute a large and rapidly growing subpopulation, 20 age-related disparities in health care merit increased attention.Although the causes of age-related disparities in care remain unclear, some researchers [21][22][23][24][25][26] however, previous studies suggest such disparities might not be the case. Mammography rates do appear to be lower in older than in younger women, 11,[28][29][30][31] even though regular mammography in older women could eliminate age-related disparities in breast cancer survival. 32 By contrast, screening rates for prostate cancer by serum prostate-specifi c antigen (PSA) testing appears to be higher in men older than 70 years than in those 50 to 65 years old, 33,34 even t...

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Age and sex differences in the management of ischaemic heart disease

Cited by 30 publications

References 28 publications

Social and gender variation in the prevalence, presentation and general practitioner provisional diagnosis of chest pain

Social and gender variation in the prevalence, presentation and general practitioner provisional diagnosis of chest pain

Access to health care resources in the UK: the case of care for arthritis

Age-Related Disparities in Cancer Screening: Analysis of 2001 Behavioral Risk Factor Surveillance System Data

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