Assessing gender bias in acute medical care in Canada

Background: Gender bias has been explored extensively in the treatment of cardiovascular disease (CVD), particularly acute myocardial infarction (AMI). Previous research is inconsistent in suggesting that women who suffer an AMI are treated less optimally than men. To date, gender bias has not been well addressed in other CVDs, specifically cerebrovascular accident (CVA), coronary revascularization, or chronic kidney disease (CKD). In an attempt to get a clearer grasp of the problem, community acquired pneumonia (CAP) was also studied and served as a non-vascular disease control. -- Methods: Using trained research nurses, retrospective chart reviews were completed for all patients admitted with AMI, CVA, for coronary revascularization, or CAP in 1995/6, 1998/9, and 2000/1 in two locations of Newfoundland (St. John's and Central Newfoundland). CKD care was analyzed using data from the STARRT (Study To Assess Renal Replacement Therapy) study, a Canadian multicentre retrospective chart review of incident dialysis patients followed for six months. All results were divided into three categories - access, intervention, and outcome - and, after controlling for baseline demographics, were explored for differences in care between men and women. -- Results: Women were often older than men and suffered from more co-morbidities and more severe medical histories, except for CAP where men were more likely to have co-morbid illnesses. Women who had suffered an AMI had a significantly longer time to thrombolytics (70 vs. 45 mins., p=0.02) and were less likely to be admitted to the CCU (84% vs. 91%, p=0.02). Women with severe CAD were more likely to receive medical management (42% vs. 28%, p=0.005) and, of the women who did receive CABG, had longer wait times in one priority for CABG group (8.0 vs. 6.0 days, p=0.05). Women began dialysis with a lower eGFR level (8.6 vs. 10.1 mL/mins., p=0.006) after receiving less pre-dialysis care than men (>1 mth. vs. <1 mth.) (80% vs. 88%, p=0.05). There was no evidence of a gender bias against women in CVA patients, in fact women were more likely to be seen by a social worker than men (43% vs. 34%, p=0.01). Of the patients receiving treatment for CAP, women were less likely than men to receive the appropriate antibiotics (AB) when considering the 1993 guidelines for AB treatment (70% vs. 78%, p=0.03). While women received less optimal access and interventions, the proportion of death between men and women for all CVDs analyzed were similar. -- Conclusions: Women are not treated with the same quality of care as men with regards to access and intervention for AMI's, coronary revascularization, and CKD. This bias was also found in a nonvascular control group. A potential gender bias in the treatment of these patients needs to be explored further.

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