Using data from a nationwide survey that represents 11 million women with heart and blood vessel diseases, Johns Hopkins Medicine researchers say women continue to report significant disparities in the care they receive compared with men.
Cardiovascular diseases, including heart attacks and strokes, have for decades persisted as the top cause of death of women in the U.S., according to the American Heart Association (AHA).
And the AHA reports an estimated 44 million women in the U.S. to have cardiovascular disease, and 1 in 3 women’s deaths each year are due to cardiovascular disease. Cardiovascular disease is also the No. 1 cause of death in men, but women have worse outcomes after certain types of heart attacks.
Cardiovascular disease and diabetes
Decades of research shows that early identification, treatment and attention to such risk factors as high blood pressure, high cholesterol levels, obesity, family history of cardiovascular disease and diabetes can substantially reduce disease burden and deaths. Lifestyle changes, smoking cessation and drugs such as statins are proven mainstays of risk reduction.
But the results of a new study, published online Dec. 10 in the Journal of the American Heart Association, add to evidence that physicians who care for women may be less conscious of and attentive to these risk factors in their female patients, and that women sense that their concerns are not taken as seriously as they should be.
"We showed that women were not getting the same level of care as men, and they feel that way too. Women are more likely to report communication problems with health care providers and dissatisfaction with their health care experience, and we think this contributes to the disparities that we see when it comes to getting preventive and other treatment for cardiovascular disease," said Erin Michos, M.D., M.H.S., associate professor of medicine at the Johns Hopkins University School of Medicine
While some metrics evaluated in the study, such as medications and hospital visits, were obtained objectively, the researchers caution that the participants’ reports of their communication and experiences with their health care providers were based upon the participants’ own ratings rather than objective standards, so those findings may be subject to this bias. The study was not designed to objectively determine whether women actually had poorer encounters than men.
Michos says past studies have shown that people with positive experiences with their health care providers report better health and better quality of life, and her team designed the new study to better understand how women (and men) with cardiovascular disease rated their experiences with health care providers and perceived their care.
For their analysis, they used survey data from the Medical Expenditure Panel Survey, which is a U.S. Department of Health and Human Services study that collected information from 21,353 adult men and women with cardiovascular disease, with several rounds of telephone interviews over two years for each participant from 2006 to 2015. The cardiovascular disease diagnosis was determined by self-reporting or medical record insurance billing codes.
Women accounted for 47of the participants. About 75% of the participants were white, 14% were African-American, 2% were Asian and 10% were Hispanic. Among the women, 5% were less than 40 years of age, 36% were aged 40–64, 23% were aged 65–74, and 36% were 75 years or older.
The participants included people who were uninsured, on private insurance, on Medicaid, and on Medicare. As for educational levels, the participants ranged from less than high school to college or graduate level.
Participants were asked to rate possible responses on patient-provider communication on a scale of 1–4, with 1 being never and 4 being always on questions such as how well their physician explained things in an easy-to-understand way, if their health care provider respected them, if their provider spent enough time with them, or if their health care provider listened to them.