Race and sex differences in rates of invasive cardiac procedures in US hospitals. Data from the National Hospital Discharge Survey.
ABSTRACT Lower rates of invasive cardiac procedures have been reported for blacks and women than for white men. However, few studies have adjusted for differences in the type of hospital of admission, insurance status, and disease severity. SETTING, DESIGN, AND PARTICIPANTS: Data from the National Hospital Discharge Survey were used to investigate race and sex differences in rates of cardiac catheterization, percutaneous transluminal coronary angioplasty, and coronary artery bypass surgery among 10,348 persons hospitalized for acute myocardial infarction.
White men consistently had the highest procedure rates, followed by white women, black men, and black women. After matching for the hospital of admission and adjusting for age, in-hospital mortality, health insurance, and hospital transfer rates (with white men as the referent), the odds ratios for cardiac catheterization were 0.67 (95% confidence interval [CI], 0.51 to 0.87) for black men, 0.72 (95% CI, 0.63 to 0.83) for white women, and 0.50 (95% CI, 0.37 to 0.68) for black women. Similar race-sex differences were noted for percutaneous transluminal coronary angioplasty and coronary artery bypass surgery.
Race and sex differentials in the rates of invasive cardiac procedures remained despite matching for the hospital of admission and controlling for other factors that influence procedure rates, suggesting that the race and sex of the patient influence the use of these procedures.
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ABSTRACT: The literature make it clear that lung cancer in women differs from that in men in several specific aspects. We conducted a retrospective study of the 967 consecutive recorded patients (696 men and 91 women after exclusions) diagnosed with small cell lung cancers (SCLC) between 1981 and 1994 in the Bas-Rhin population-based cancer registry to determine if such particularities could be observed in SCLC. Data included demographic and social characteristics, medical and smoking history, management (diagnosis and treatment), hospitalisation and survival. The end point for survival was 31 December 1998. Women were more frequently single, divorced, or widowed (P=0.007) and lived more often in urban areas (places with more than 10 000 inhabitants) (P=0.017). They differed significantly from men in their tobacco exposure (P=0.0001) and non-smoking rates (P=0.0003) but not in clinical presentation, except for more frequently elevated LDH levels (P=0.02). Bone marrow biopsies were more often performed in men (P=0.004), but management was otherwise comparable. The mean number of hospitalisations (for any reason) was comparable in both sexes but women tended to remain hospitalised longer (P=0.057). Overall survival did not differ, but women older than 70 years died sooner than their male counterparts (P=0.026). Our study confirms that some of gender differences reported in the lung cancer literature exist in SCLC. Sex-related differences in LDH levels have not previously been reported, to our knowledge. North American and European data concerning survival among women and men are discordant. Whether these gender differences are related to a real difference between the sexes or simply to differential exposure to carcinogens remains to be determined.Lung Cancer 11/2003; 42(2):141-152. · 3.39 Impact Factor
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ABSTRACT: In 2002, the Institute of Medicine (IOM) issued Unequal Treatment: Confronting Racial and Ethnic Disparities in Healthcare, a report on disparities in quality of care within health-care settings. This landmark report succeeded at placing the issue of health disparities squarely on the nation’s health policy agenda, leading to increased attention and resources devoted to understanding and ultimately solving this long-standing and vexing problem. Unequal Treatment (The IOM Report) focused on health-care disparities, which are to be distinguished from health status disparities (which are covered in another section of this book). While health status disparities relate to disparities in the pattern of morbidity, mortality, and disability, health-care disparities relate to disparities within the health-care system: access to and utilization of health services, and quality of care received. The objective of this review is to summarize the recent literature on health-care disparities. Specifically, this review examines racial/ethnic discrimination within health-care settings. In selecting articles for inclusion in this review, we established a set of criteria to focus on the scope of the project. To be included in this review, articles had to meet the following criteria: (1) based on a US population; (2) published in English in a peer-reviewed journal, book, or government or other report; (3) topic of the article is racial/ethnic differences in health services or racial discrimination or racism in the health-care setting. Studies of discrimination outside of the health-care setting are not included. We searched the National Library of Medicine PubMed database, which combines the Medline and Pre-Medline databases. PubMed includes bibliographic listings from more than 4,000 biomedical journals published in the United States and 70 other countries. It contains over ten million citations dating from 1966 to the present. PubMed is the most widely used computerized search tool for medical information and is very comprehensive. In addition to articles selected via PubMed, we searched the reference list from each article that met our criteria to search for additional articles that were not detected in the PubMed searches. This included book chapters and other papers that were not published in peer-reviewed scientific journals. After the elimination of duplicates, this procedure resulted in a total of 496 articles that met the inclusion criteria. Each article was summarized with respect to its study objectives, data sources used in the study (administrative data, vital data, medical records, questionnaire, and others), the specific measure(s) of discrimination used in the study, and the study’s key findings.