Abstract
Objectives
To measure the extent to which gender differences in poor lipid control among individuals
at risk for cardiovascular diseases could be explained by patient-level characteristics.
Study Design
Cross-sectional analyses of merged Veteran Health Administration (VHA) and Medicare
claims data for the fiscal years (FY) 2002 and 2003 consisting of veterans using VHA
facilities and were diagnosed with diabetes or heart disease or hypertension during
FY 2002 and had recorded LDL cholesterol values in FY2003 (N = 527,568). There were
10,582 women and 516,986 men veterans. Poor lipid control was defined as LDL cholesterol
values ≥130 mg/dL. Multivariate techniques consisted of logistic regressions. Based
on the parameter estimates and distribution of individual characteristics, we used
a decomposition technique to analyze factors that contributed to the gender difference
in poor lipid control.
Principal Findings
A significantly higher percent of women (27.4%) than men (17.1%) had LDL cholesterol
values ≥130 mg/dL. Of the 10.3 percentage point difference in lipid control, 3.4 percentage
points were explained by variables included in the model. The gender difference in
poor lipid control was mostly explained by age, physical illnesses, use of lipid lowering
medications and depression.
Conclusions
Only one-third of the gender difference in poor lipid control could be explained by
differences in individual characteristics, some of which are modifiable or could be
used to identify groups at risk with poor lipid control. Our findings suggest that
gender differences in lipid control could be partially reduced by increasing the prescription
of lipid lowering drugs and treating depression among women. Interventions that improve
lipid control in the non-elderly will also benefit women. However the largest part
of the difference in lipid control between women and men remains unexplained and further
research is needed to identify additional modifiable and unmodifiable factors.
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Biography
Usha Sambamoorthi, PhD, is a professor at West Virginia University. She is a health services researcher and health economist with expertise in disparities research by gender, race/ethnicity, disability, age, and geography in individuals with complex chronic illness.
Biography
Sophie Mitra, PhD, is an economics professor at Fordham University whose main expertise is in understanding the economic consequences and determinants of disability.
Biography
Patricia A. Findley, DrPH, MSW, LCSW, is an assistant professor of social work at Rutgers University whose expertise is in exploring issues related to chronic illness and disability and how they impact individuals’ ability to receive care and live in the community.
Biography
Leonard Pogach, MD, MBA, is the VHA National Program Director for Diabetes and professor of medicine at the University of Medicine and Dentistry of New Jersey. His research is focused on guideline and performance measurement development and evaluation of quality of care for veterans with diabetes.
Article info
Publication history
Published online: December 02, 2011
Accepted:
August 26,
2011
Received in revised form:
August 25,
2011
Received:
April 1,
2010
Footnotes
Supported by grants from the Department of Veterans Affairs-Health Services Research and Development Service: IEA-05-255; IIR-05-016; Diabetes Epidemiology Cohort. The findings and opinions reported here are those of the authors and do not necessarily represent the views of any other individuals or organizations.
Identification
Copyright
© 2012 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.
