Gender disparities in heart disease and diabetes managed care

May 16 2007

Women with heart disease and diabetes are less likely to receive several types of routine outpatient medical care than men who have similar health problems, according to a RAND Corporation study issued today.

While previous research has shown that women less frequently receive expensive medical care such as angioplasty for heart disease, few studies have evaluated gender disparities in managed care settings.

All the patients in the RAND Health study had either private insurance or were enrolled in Medicare managed care plans, had been diagnosed with heart disease and/or diabetes, and had visited health providers to receive care. The study is published in the May/June edition of the journal Women's Health Issues.

"We found that the routine medical care received by women for their heart disease and diabetes was not as good as the care received by men," said Chloe Bird, the study's lead author and a sociologist at RAND, a nonprofit research organization. "These are low-cost treatments that can forestall serious health problems in the future -- and women with diabetes and heart disease are not receiving them as often as men with similar problems."

Researchers studied more than 50,000 men and women enrolled in both commercial and Medicare managed care plans in 1999. The study examined 11 different screening tests, treatments or measurements of health status shown to be important to all people diagnosed with heart disease or diabetes.

Among people enrolled in commercial health plans, women were significantly less likely than men to receive the care evaluated in six of the 11 measures, while women enrolled in the Medicare plans were less likely to receive the care evaluated in four of the 11 measures.

The largest disparity found by researchers was that women were less likely to lower their cholesterol to recommended levels after suffering a heart attack or other acute cardiac event, or if they had diabetes.

For example, women with diabetes were 19 percent less likely than men to have their cholesterol within recommended ranges if they were enrolled in Medicare and 16 percent less likely than men to have cholesterol with recommended ranges if enrolled in commercial health plans.

Other types of care women received less often than men included being prescribed ACE inhibitor drugs for chronic heart failure and receiving prescriptions for beta blocker drugs following a heart attack.

Women with diabetes in both Medicare and commercial health plans were more likely to have received eye exams than their male peers.

The disparities were found among women even though they generally see a doctor or other health care provider more often than men. The disparities also remained after researchers accounted for socioeconomic factors that may influence care.

"These were all insured people. They all had access to medical care and they were all diagnosed with these diseases," Bird said. "The disparities cannot be explained by a lack of patient reporting or not recognizing the symptoms of a disease."

Bird said that more research needs to be done to understand why there are gender differences in outpatient care.

"As we become a nation with an older population, the type of routine preventive care we studied will become even more important," Bird said. "Understanding these gender differences may allow us to improve care."

The RAND study is one of four published in the latest edition of Women's Health Issues reporting on studies that found gender disparities among patients treated in managed care settings.

"Taken together, these studies make a compelling case for routine assessment and reporting of selected quality indicators by gender," said Dr. Allen Fremont, the lead author of an accompanying editorial and co-author of the RAND study. Fremont is a natural scientist and sociologist at RAND.