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Sex Differences in Cardiac Catheterization
The Role of Physician Gender
Saif S. Rathore, MPH;
Jersey Chen, MD,MPH;
Yongfei Wang, MS;
Martha J. Radford, MD;
Viola Vaccarino, MD,PhD;
Harlan M. Krumholz, MD
JAMA. 2001;286:2849-2856.
Context Many studies indicate that women are less likely than men to undergo cardiac procedures after an acute myocardial infarction (AMI), raising concerns of sexual bias in clinical care. However, no data exist regarding the relationship between patient sex, physician sex, and use of cardiac procedures.
Objective To determine whether sex differences in cardiac catheterization after AMI were greater when patients were treated by male attending physicians compared with female attending physicians.
Design, Setting, and Patients Analysis of data from the Cooperative Cardiovascular Project, a retrospective medical record review. A total of 104 231 Medicare fee-for-service beneficiaries who were hospitalized in US acute care hospitals for an AMI between January 1994 and February 1995.
Main Outcome Measure Use of cardiac catheterization within 60 days of admission, compared between the 4 groups of patient sex–physician sex combinations.
Results Women underwent fewer cardiac catheterizations than men when treated by either male physicians (38.6% vs 50.8%; P = .001) or female physicians (34.8% vs 45.8%; P = .001). Sex differences in procedure use were not greater when a patient and physician were of different sexes (P for interaction = .85). After potential confounders in multivariable analysis were accounted for, women were less likely to undergo cardiac catheterization (risk ratio, 0.90 [95% confidence interval {CI}, 0.88-0.92]), regardless of the treating physician's sex. Patients treated by male physicians were more likely to undergo cardiac catheterization (risk ratio, 1.06 [95%CI, 1.02-1.10]) than those treated by female physicians, regardless of patient sex.
Conclusions Women who have had an AMI undergo a cardiac catheterization less often than men, whether treated by a male or female physician. These results suggest that factors other than sexual bias by male physicians toward women account for sex differences in cardiac procedure use.
Author Affiliations: Section of Cardiovascular Medicine, Department of Medicine, Yale University School of Medicine (Messrs Rathore and Wang and Drs Radford and Krumholz), Yale–New Haven Hospital Center for Outcomes Research and Evaluation (Drs Radford and Krumholz), and Section of Health Policy and Administration, Department of Epidemiology and Public Health, Yale University School of Medicine (Dr Krumholz), New Haven, Conn; Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia (Dr Chen); Qualidigm, Middletown, Conn (Drs Radford and Krumholz); and Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Ga (Dr Vaccarino).
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