Race and sex differences in the management of coronary artery disease

被引:129
作者
Sheifer, SE
Escarce, JJ
Schulman, KA
机构
[1] Duke Clin Res Inst, Ctr Clin & Genet Econ, Durham, NC 27715 USA
[2] Georgetown Univ, Med Ctr, Dept Med, Div Cardiol, Washington, DC 20007 USA
[3] RAND Corp, Hlth Sci Program, Santa Monica, CA USA
关键词
D O I
10.1016/S0002-8703(00)90017-6
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Although numerous studies have documented race and sex differences in the treatment of coronary artery disease, the available analyses have not been comprehensively evaluated. In this review, we summarize prior estimates of race and sex disparities in the utilization of standard tests and therapies, and we evaluate studies of factors that may contribute to gaps in care. The studies presented consistently demonstrate that blacks and women with coronary artery disease, compared with whites and men, are substantially less likely to receive standard interventions. Studies also indicate that racial differences relate in part to socioeconomic Factors, process-of-care variables, and patient preferences, whereas sex differences relate in part to clinical factors. In both cases, however, our understanding is limited by deficiencies in currently available datasets. Moreover, factors that have been shown to contribute to race and sex disparities in medical care fail to explain them fully. In both cases, physician decisionmaking appears to contribute as well, suggesting that subconscious biases may contribute to treatment disparities. We conclude by proposing initiatives to remedy race and sex disparities in medical care. Efforts should focus on increasing physician aware ness of this problem. Studies should gather data that are currently unavailable for analysis, including detailed clinical variables and patient-level socioeconomic information. Finally, novel quality assurance programs, designed to evaluate and improve the care of blacks and women with coronary artery disease, should be promptly undertaken.
引用
收藏
页码:848 / 857
页数:10
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