Diferencias entre mujeres y varones en el acceso a procedimientos cardiovasculares intervencionistas en los hospitales públicos de Andalucía

Abstract

Introduction and objectives. The aim of this study was to determine whether there are differences between women's and men's access to coronary revascularization procedures for acute coronary syndrome in Andalusia, Spain. Methods. This observational multicenter study was based on the Andalusian Minimum Basic Data Set (CMBDA). The study included all hospitalizations at public hospitals in the period 2000-2003 that involved emergency admission and in which the principal diagnosis was acute myocardial infarction or unstable angina. There were 46 007 cases (16 391 women and 29 616 men). The relationships between sex and the use of cardiac catheterization, percutaneous transluminal coronary angioplasty and coronary artery bypass grafting were analyzed. Patients were categorized according to age, principal diagnosis, and comorbidity (Charlson index). Multivariate logistic regression analysis, which included adjustment for the other variables, was used to determine the association between sex and procedure use. Results. Women in the study population were older and had more severe comorbidity than men. They underwent diagnostic and therapeutic procedures less frequently, irrespective of age group, diagnosis, and comorbidity. After adjusting for age, diagnosis, and comorbidity, the odds ratio (reference category: men) was 0.68 (95% Cl, 0.64-0.72) for cardiac catheterization, 0.61 (95% Cl, 0.57-0.66) for percutaneous transluminal coronary angioplasty, and 0.38 (95% Cl, 0.29-0.50) for coronary artery bypass grafting. Conclusions. During hospitalization for acute coronary syndrome, women less frequently had access to interventional cardiovascular procedures than men. Further research is needed to clarify the roles played by social, cultural and biological factors in determining the observed differences.