Table 2.
Possible Mechanisms for Gender Disparities in Patients with Cardiovascular Disease
| References | |
|---|---|
| Possible patient factors | |
| Decreased access to care among uninsured women | 28,29 |
| Cost barriers greater in women | 27,34 |
| Lower socioeconomic status* | 14,35 |
| Women's prioritization of cholesterol below gender-specific screening* | 36,37 |
| Women's perception of CVD risk compared with risk of other diseases* | 38 |
| Women's different communication and decision-making preferences | 41,42,44 |
| Women's increased age* | 48,132 |
| African-American race | 8,50 |
| Increased comorbidity | 1,56 |
| Women's lower rate of revascularization | 48,58 |
| Substitution of hormone replacement therapy for lipid-specific therapy* | 61 |
| Possible provider factors | |
| Perception of CVD risk inappropriately low; treatment threshold in women inappropriately high* | 49,60,77,78 |
| Perception of CVD risk higher for revascularized patients, but women undergo revascularization less | 22,58 |
| Cardiologists specialty protective, but women may see them less frequently* | 80,81,84,85 |
| Providers prioritize cholesterol management below other gender-specific screening* | 87 |
| Providers overestimate the amount of care they provide for women more than men | 108 |
| Women physician's different communication and decision-making preferences | 43 |
| Younger physicians with more recent training more likely to enforce prevention, less likely to see women | 93,94 |
| Possible system factors | |
| Case-management programs and lipid clinics may reduce gender disparities* | 97,99 |
| Cardiac rehabilitation programs underused by women* | 100,134 |
| Measurement factors | 107 |
| Other health system factors such as profit status, model type, referral management? | – |
*
This factor has already been demonstrated to differ between men and women with cardiovascular disease (CVD) for dyslipidemia screening, treatment, or goals.