This paper provides important insights on gender differences across racial and ethnic groups in a Medicare population in terms of the quality of care received for acute myocardial infarction (AMI) and congestive heart failure (CHF) in association with diabetes or hypertension/end-stage renal disease (ESRD). Both race/ethnicity and gender are associated with differences in the diagnostic evaluation and treatment of Medicare recipients with these conditions. In the AMI group, non-Hispanic Black and Hispanic patients of both genders were less likely to receive aspirin or β-blockers than non-Hispanic Whites. These differences persisted for Hispanic women and men even when they presented with ESRD or diabetes. Rates for smoking cessation counseling were among the lowest among non-Hispanic Blacks and Hispanics with AMI–diabetes and non-Hispanic blacks with AMI–hypertension/ESRD. Gender comparisons within racial groups for the AMI and AMI–diabetes groups show that among non-Hispanic Whites, women were less likely to receive aspirin and β-blockers. No gender differences were noted among non-Hispanic Black and Hispanic Medicare recipients. In the CHF group, Hispanics were the racial/ethnic group least likely to have an assessment of left ventricular function (LVF), even if they had diabetes and had lower rates of angiotensin-converting enzyme inhibitor therapy or even if they had combined CHF–hypertension/ESRD. Gender comparisons in both the CHF and CHF–hypertension/ESRD groups show that non-Hispanic White women were less likely to have an LVF assessment than non-Hispanic White men. Among all subjects, having comorbidities with AMI was not associated with higher markers of quality cardiovascular care. Closing the many gaps in cardiovascular care must target the specific needs of women and men across racial and ethnic groups.
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Rosaly Correa-de-Araujo, MD, MSc, PhD, is a cardiovascular pathologist trained at the National Heart, Lung, and Blood Institute. As the Agency for Healthcare Research and Quality’s Director of Women’s Health and Gender-based Research, Dr. Correa oversees the development of a national research agenda for women in consultation with prominent members of the research community and other government agencies. Her main areas of interest include gender-based research and analysis particularly related to chronic diseases, medication use outcomes and safety, and disparities in health care.
Beth Stevens, MS, is a Biostatistician with the Colorado Foundation for Medical Care. She serves as the lead statistician for the Centers for Medicare & Medicaid Services—funded National Heart Care Quality Improvement Project.
Ernest Moy, MD, MPH, is a Senior Service Fellow with the Center for Quality Improvement and Patient Safety in the Agency for Healthcare Research and Quality. Dr. Moy leads the development of the National Healthcare Disparities Report.
David S. Nilasena MD, MSPH, MS, is a Medical Officer with the Centers for Medicare & Medicaid Services.
Francis Chesley, MD, is the Director of the Office of Extramural Research, Education, and Priority Populations in the Agency for Healthcare Research and Quality.
Kelly McDermott, MA, is currently a predoctoral student in health services research at the University of Washington in Seattle.
Accepted: April 18, 2005
Received in revised form: February 24, 2005
Received: October 4, 2004
The views expressed in this article are those of the authors and do not necessarily represent the views of the Agency for Healthcare Research and Quality or the Federal government.
© 2006 Jacobs Institute of Women’s Health. Published by Elsevier Inc. All rights reserved.