Studies have shown that women with cardiovascular disease (CVD) are screened and treated less aggressively than men and are less likely to undergo cardiac procedures. Research in this area has primarily focused on the acute setting, and there are limited data on the ambulatory care setting, particularly among the commercially insured. To that end, the objective of this study is to determine if gender disparities in the quality of CVD care exist in commercial managed care populations.
Using a national sample of commercial health plans, we analyzed member-level data for 7 CVD quality indicators from the Healthcare Effectiveness Data and Information Set (HEDIS®) collected in 2005. We used hierarchical generalized linear models to estimate these HEDIS measures as a function of gender, controlling for race/ethnicity, socioeconomic status, age, and plans’ clustering effects.
Results showed that women were less likely than men to have low-density lipoprotein (LDL) cholesterol controlled at <100 mg/dL in those who have diabetes (odds ratio [OR], 0.81; 95% confidence interval [CI], 0.76–0.86) or a history of CVD (OR, 0.72; CI 95%, 0.64–0.82). The difference between men and women in meeting the LDL control measures was 5.74% among those with diabetes (44.3% vs. 38.5%) and 8.53% among those with a history of CVD (55.1% vs. 46.6%). However, women achieved higher performance than men in controlling blood pressure (OR, 1.12; 95% CI, 1.02–1.21), where the rate of women meeting this quality indicator exceeded that of men by 1.94% (70.8% for women vs. 68.9% for men).
Gender disparities in the management and outcomes of CVD exist among patients in commercial managed care plans despite similar access to care. Poor performance in LDL control was seen in both men and women, with a lower rate of control in women suggesting the possibility of less intensive cholesterol treatment in women. The differences in patterns of care demonstrate the need for interventions tailored to address gender disparities.
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Ann F. Chou, PhD, MPH, is an Assistant Professor in the Department of Health Administration and Policy at the University of Oklahoma College of Public Health and College of Medicine. She is a health services researcher whose interests focus on implementation of best practices and quality of care.
Sarah Hudson Scholle, MPH, DrPH, is Assistant Vice President for Research at the National Committee for Quality Assurance in Washington, DC. She is a health services researcher, and her current research focuses on quality measurement, women’s health, and disparities.
Carol S. Weisman, PhD, is Professor of Health Evaluation Sciences and Obstetrics and Gynecology at the Pennsylvania State University College of Medicine. She is a sociologist and health services researcher whose research focuses on women’s health, health care, and health policy.
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 and Senior Scientist at the Centre for Inner City Health Research, St. Michaels Hospital, Toronto. Her research focuses on improving quality and outcomes of care for older adults with chronic illness.
Rosaly Correa-de-Araujo, MD, MSc, PhD, is the Director of the Office of the Americas, Office of Global Health Affairs and a cardiovascular pathologist trained at the National Heart, Lung, and Blood Institute. 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.
Lori Mosca, MD, PhD, is Director of Preventive Cardiology at the New York-Presbyterian Hospital and Associate Professor of Medicine at Columbia University. She holds an NIH research career award in patient oriented research in applied preventive cardiology.
Published online: April 24, 2007
Accepted: March 13, 2007
Received in revised form: January 11, 2007
Received: December 22, 2006
© 2007 Jacobs Institute of Women’s Health. Published by Elsevier Inc. All rights reserved.