Sex/gender bias in the management of chest pain in ambulatory care

Abstract

Objective:Cardiovascular diseases (CVD) are the main cause of death worldwide and despite a higher prevalence in men, mortality from CVD is higher among women. Few studies have assessed sex differences in chest pain management in ambulatory care. The objective of this post hoc analysis of data from a prospective cohort study was to assess sex differences in the management of chest pain in ambulatory care.Setting:We used data from the Thoracic Pain in Community cohort study that was realized in 58 primary care practices and one university ambulatory clinic in Switzerland.Participants:In total, 672 consecutive patients aged over 16 years attending a primary care practice or ambulatory care clinic with a complaint of chest pain were included between February and June 2001. Their mean age was 55.2 years and 52.5% were women.Main outcome measures:The main outcome was the proportion of patients referred to a cardiologist at 12 months follow-up. A panel of primary care physicians assessed the final diagnosis retained for chest pain at 12 months.Results:The prevalence of chest pain of cardiovascular origin (n = 108, 16.1%) was similar for men and women (17.5% vs 14.8%, respectively, p = 0.4). Men with chest pain were 2.5 times more likely to be referred to a cardiologist than women (16.6% vs 7.4%, odds ratio: 2.49, 95% confidence interval: 1.52–4.09). After adjustment for the patients’ age and cardiovascular disease risk factors, the estimates did not significantly change (odds ratio: 2.30, 95% confidence interval: 1.30–3.78).Conclusion:Although the same proportion of women and men present with a chest pain of cardiovascular origin in ambulatory care, there is a strong sex bias in their management. These data suggest that effort must be made to assure equity between men and women in medical care.

The influence of patient race on the use of diagnostic imaging in United States emergency departments: data from the National Hospital Ambulatory Medical Care survey

“…Gender-based health care disparities have been found by investigators in other contexts. This includes critical differences in chest pain management in ambulatory care in men vs. women, with men being 2.5 times more likely to be referred to a cardiologist than women [47]. Gender bias in health care has been well documented, [48][49][50], but further investigation of gender differences in the use of diagnostic imaging is warranted with more specifically defined clinical scenarios before firm conclusions can be drawn.…”

Gender awareness among medical students in a Swiss University

“…Gender stereotypes influence physician's differential diagnosis and decisions of management. A common example of stereotypes is found in cardiovascular disease, where coronary heart disease is often underdiagnosed in women due to a different, biased management [8,9]. Gender stereotypes are acquired in society through socialization of both men and women and are rooted in gendered roles, identities and representations.…”

Pain in the Prehospital Setting in Rwanda: Results of a Mixed-Methods Quality Improvement Project

“…For example, studies have found different pain modalities to be perceived differently by men and women [ 28 , 29 ]. Although some variations in pain expression exist, gender-based treatment of pain may have a negative impact on patient care such as fewer referrals to specialist physicians [ 29 , 30 ]. Studies specific to analgesics administration in the prehospital setting have shown that women often receive less medications than men for similar injuries [ 31 , 32 ].…”