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.
Keywords
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Biography
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.
Biography
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.
Biography
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.
Biography
David S. Nilasena MD, MSPH, MS, is a Medical Officer with the Centers for Medicare & Medicaid Services.
Biography
Francis Chesley, MD, is the Director of the Office of Extramural Research, Education, and Priority Populations in the Agency for Healthcare Research and Quality.
Biography
Kelly McDermott, MA, is currently a predoctoral student in health services research at the University of Washington in Seattle.
Article info
Publication history
Accepted:
April 18,
2005
Received in revised form:
February 24,
2005
Received:
October 4,
2004
Footnotes
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.
Identification
Copyright
© 2006 Jacobs Institute of Women’s Health. Published by Elsevier Inc. All rights reserved.
