This presentation is part of: Oral Concurrent Session B - Health Services Research
GENDER DISPARITIES IN PERCUTANEOUS CORONARY INTERVENTIONS IN PENNSYLVANIA
Christopher S. Hollenbeak, PhD1, Carol S. Weisman, PhD2, Michael Rossi, MD3, and Steven M. Ettinger, MD1. (1) Penn State College of Medicine, Surgery & Health Evaluation Sciences, Hershey, PA, (2) Penn State College of Medicine, Health Evaluation Sciences, Hershey, PA, (3) Lehigh Valley Hospital, Medicine, Allentown, PA
Purpose. The purpose of this research was to determine whether there were gender disparities in the use of percutaneous coronary interventions (PCI) in the treatment of acute myocardial infarction (AMI) in Pennsylvania and, if so, whether outcomes were affected. Methods. Data were provided by the Pennsylvania Health Care Cost Containment Council (PHC4) and included all AMI patients at all acute care hospitals in the state of Pennsylvania during the year 2000. The population was stratified by gender to identify disparities in treatment and outcomes. Multivariate analyses were performed using binary logistic regression. Retrospective matching on propensity scores was performed using a “greedy” matching algorithm. Results. During the year 2000, 10,170 (32.4%) AMI patients were treated with PCI and 21,181 (67.6%) patients were medically managed in Pennsylvania hospitals. Across all patients, women were significantly less likely to get PCI than men (23.9% vs. 40%, p<0.0001) and were also more likely to die in the hospital (12.7% vs. 9.7%, p<0.0001). Restricting the sample to patients treated at hospitals where PCI was available, women were significantly less likely than men to get receive the intervention (34.4% vs. 65.4%, p<0.0001). They were also more likely to die than men when treated at hospitals offering PCI (10.1% vs. 7.3%, p<0.0001). These disparities in treatment and outcomes were confirmed in multivariate analyses. After controlling for age, race, severity at admission, type of infarct, and source of admission, women still had a 25% lower odds than men of getting PCI (p<0.0001) regardless of the availability of PCI. Finally, we used propensity score methods to match 3,022 women who received PCI to 3,022 women who did not. Results showed that women who received PCI were significantly less likely to die (2.4% vs. 10.7%, p<0.0001). Conclusions. In Pennsylvania, women appear to be less likely to be treated for AMI with PCI. Furthermore, PCI is strongly associated with better outcomes. Although there were factors we could not control, including location of infarct, time from symptom onset to treatment, and patient preferences, these results suggest that the morbidity and mortality associated with AMI in women could be reduced by increased used of PCI.
