Article| Volume 17, ISSUE 3, P131-138, May 2007

Does Quality of Care for Cardiovascular Disease and Diabetes Differ by Gender for Enrollees in Managed Care Plans?

Published:April 19, 2007DOI:


      To assess gender differences in the quality of care for cardiovascular disease and diabetes for enrollees in managed care plans.


      We obtained data from 10 commercial and 9 Medicare plans and calculated performance on 6 Health Employer Data and Information Set (HEDIS) measures of quality of care (β-blocker use after myocardial infarction [MI], low-density lipoprotein cholesterol [LDL-C] check after a cardiac event, and in diabetics, whether glycosylated hemoglobin [HgbA1c], LDL cholesterol, nephropathy, and eyes were checked) and a 7th HEDIS-like measure (angiotensin-converting enzyme [ACE] inhibitor use for congestive heart failure). A smaller number of plans provided HEDIS scores on 4 additional measures that require medical chart abstraction (control of LDL-C after cardiac event, blood pressure control in hypertensive patients, and HgbA1c and LDL-C control in diabetics). We used logistic regression models to adjust for age, race/ethnicity, socioeconomic status, and plan.

      Main Findings

      Adjusting for covariates, we found significant gender differences on 5 of 11 measures among Medicare enrollees, with 4 favoring men. Similarly, among commercial enrollees, we found significant gender differences for 8 of 11 measures, with 6 favoring men. The largest disparity was for control of LDL-C among diabetics, where women were 19% less likely to achieve control among Medicare enrollees (relative risk [RR] = 0.81; 95% confidence interval [CI] = 0.64–0.99) and 16% less likely among commercial enrollees (RR = 0.84; 95%CI = 0.73–0.95).


      Gender differences in the quality of cardiovascular and diabetic care were common and sometimes substantial among enrollees in Medicare and commercial health plans. Routine monitoring of such differences is both warranted and feasible.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Women's Health Issues
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Anderson R.N.
        • Smith B.L.
        Deaths: Leading causes for 2002 national vital statistics reports. National Center for Health Statistics, Hyattsville, MD2005 (Vol. 53)
        • Berlowitz D.R.
        • Ash A.S.
        • Hickey E.C.
        • Friedman R.H.
        • Glickman M.
        • Kader B.
        • et al.
        Inadequate management of blood pressure in a hypertensive population.
        New England Journal of Medicine. 1998; 339: 1957-1963
        • Committee on Quality of Health Care in America
        Crossing the quality chasm: A new health system for the 21st century. National Academy Press, Washington, DC2001
        • Correa-de-Araujo R.
        • McDermott K.
        • Moy E.
        Gender differences across racial and ethnic groups in the quality of care for diabetes.
        Women’s Health Issues. 2006; 16: 56-65
        • Correa-de-Araujo R.
        • Stevens B.
        • Moy E.
        • Nilasena D.
        • Chesley F.
        • McDermott K.
        Gender differences across racial and ethnic groups in the quality of care for acute myocardial infarction and heart failure associated with comorbidities.
        Women’s Health Issues. 2006; 16: 44-55
        • Fiscella K.
        • Fremont A.
        Use of geocoding and surname analysis to estimate race and ethnicity.
        Health Services Research. 2006; 41: 1482-1500
        • Fremont A.M.
        Socioeconomic, racial/ethnic, and gender differences in quality and outcomes of care as it relates to cardiovascular disease. RAND Corporation, Santa Monica, CA2002
        • Fremont A.M.
        • Bierman A.S.
        • Wickstrom S.L.
        • Bird C.E.
        • Shah M.M.
        • Escarce J.J.
        • et al.
        Use of geocoding in managed care settings to identify disparities in quality of care.
        Health Affairs. 2005; 24: 516-526
        • Health Plan Employer Data and Information Set (HEDIS)
        Measuring the quality of America’s health care (No. 10235-100-00). National Committee for Quality Assurance (NCQA), Washington, DC1999
        • Hyman D.J.
        • Pavlik V.N.
        Characteristics of patients with uncontrolled hypertension in the United States.
        New England Journal of Medicine. 2001; 345: 479-486
        • Krieger N.
        Overcoming the absence of socioeconomic data in medical records: Validation and application of a census-based methodology.
        American Journal of Public Health. 1992; 82: 703-710
        • Krieger N.
        • Williams D.R.
        • Moss N.E.
        Measuring social class in US public health research: Concepts, methodologies, and guidelines.
        Annual Review of Public Health. 1997; 18: 341-378
        • Lee W.L.
        • Cheung A.M.
        • Cape D.
        • Zinman B.
        Impact of diabetes on coronary artery disease in women and men.
        Diabetes Care. 2000; 23: 962-968
        • Legato M.J.
        Dyslipidemia, gender, and the role of high-density lipoprotein cholesterol: Implications for therapy.
        American Journal of Cardiology. 2000; 86: 15L-18L
        • Liao Y.
        • Cooper R.S.
        • Ghali J.K.
        • Lansky D.
        • Cao G.
        • Lee J.
        Sex differences in the impact of coexistent diabetes on survival in patients with coronary heart disease.
        Diabetes Care. 1993; 16: 708-713
        • Lucas F.L.
        • DeLorenzo M.A.
        • Siewers A.E.
        • Wennberg D.E.
        Temporal trends in the utilization of diagnostic testing and treatments for cardiovascular disease in the United States, 1993–2001.
        Circulation. 2006; 113: 374-379
      1. National Center for Health Statistics. (2001). Health, United States, 2001, with urban and rural health chartbook. Hyattsville, MD.

        • National Center for Health Statistics
        Health, United States, 2006 with Chartbook on Trends in the Health of Americans. Author, Hyattsville, MD2006
      2. National Committee for Quality Assurance (NCQA). (2002). Available: Accessed August 7, 2002.

        • Rathore S.S.
        • Berger A.K.
        • Weinfurt K.P.
        • Feinleib J.
        • Oetgen W.J.
        • Gersh B.J.
        • et al.
        Race, sex, poverty, and the medical treatment of acute myocardial infarction in the elderly.
        Circulation. 2000; 102: 642-648
        • Trivedi A.N.
        • Zaslavsky A.M.
        • Schneider E.C.
        • Ayanian J.Z.
        Trends in the quality of care and racial disparities in Medicare managed care.
        New England Journal of Medicine. 2005; 353: 692-701
        • Vacarrino V.
        • Krumholz H.M.
        • Yarzebski J.
        • Gore J.M.
        • Goldberg R.J.
        Sex differences in 2-year mortality after hospital discharge for myocardial infarction.
        Annals of Internal Medicine. 2001; 134: 173-181
        • Zhang J.
        • Yu K.F.
        What’s the relative risk?.
        Journal of the American Medical Association. 1998; 280: 1690-1691


      Chloe E. Bird, PhD, is a sociologist with interests in gender differences in mental and physical health and health care. She is currently completing a book with Patricia Rieker titled Gender and Health: The Effects of Constrained Choice and Social Policies in which they examine how differences in the social organization of men’s and women’s lives contribute to differences in their health.


      Allen M. Fremont, MD, PhD, is a physician, sociologist, and health services researcher. His research focuses on reducing social disparities in and improving overall quality of care.


      Arlene S. Bierman, MD, MS, holds the Ontario Women’s Health Council Chair in Women’s Health and is Associate Professor of Medicine; Health Policy, Management and Evaluation: and Nursing at the University of Toronto. She is a Senior Scientist at the Center for Inner City Health Research, St. Michaels Hospital, Toronto.


      Steve Wickstrom, MS, is the Senior Director of Research and Development and currently is focusing on health care risk assessment.


      Mona Shah, MS, is Research Manager. Her research interests include comparing cost, utilization, and quality for different health plan populations with focus on consumer-driven health plans and managed care plans.


      Thomas Rector, PharmD, PhD, currently works as an investigator in a Center for Chronic Disease Outcomes Research.


      Thomas Horstman, BS, is a Lead Programmer Analyst specializing in SAS programming for Health Economic & Outcomes Research studies using large, administrative database. His previous work at the Center for Health Care Policy and Evaluation involved HEDIS reporting, cost and utilization reporting, database development, as well as FDA and other government sponsored studies.


      José J. Escarce, MD, PhD, is Professor of Medicine at the David Greffen School of Medicine at UCLA and Senior Natural Scientist at RAND. His research addresses racial/ethnic and socioeconomic disparities in health and health care.