Sex inequalities in ischaemic heart disease in general practice: cross sectional survey

Abstract

Objective: To study differences in treatment for men and women with ischaemic heart disease by using standards defined in England's national service framework for coronary artery disease. Design: Cross sectional survey using routinely collected data. Setting: 18 practices in 18 primary care groups in Trent Region. Subjects: 5891 men and women aged over 35 years with a diagnosis of ischaemic heart disease or prescription for nitrates recorded on computer. Main outcome measure: Difference in the proportion of men and women with ischaemic heart disease and taking lipid lowering treatment. Results: Women were less likely than men to have a recording of body mass index (79% (2197/2783) v 82% (2552/3102), P=0.002), smoking (86% (2386) v 89% (2779), Pv 96% (2986), P=0.04). Women were also less likely to have a recording of fasting cholesterol concentration (35% (968) v 50% (1550), Pv 20% (514/2552), Pv 52% (1553/2986), Pv 67% (1043/1550), Pv 71% (1979), Pv 10% (274), Pv 21% (596), PConclusion: The results suggest a systematic bias towards men compared with women in terms of secondary prevention of ischaemic heart disease. What is already known on this topic England's national service framework for coronary artery disease requires general practitioners to identify and treat patients at high risk of ischaemic heart disease Substantial evidence of sex inequality for this disease exists for access to secondary care less but less is known about equity for its management in general practice What this study adds Among patients with ischaemic heart disease, men were more likely than women to have cardiovascular risk factors and serum cholesterol concentration recorded on computer A higher proportion of women, however, had raised cholesterol concentrations recorded on computer, but more men were treated with lipid lowering drugs The results suggest a systematic bias towards men compared with women in terms of secondary prevention of ischaemic heart disease.