Logo of brjgenpracRCGP homepageJ R Coll Gen Pract at PubMed CentralBJGP at RCGPBJGP at RCGP
Br J Gen Pract. Dec 1999; 49(449): 963–966.
PMCID: PMC1313580

Sex differences in cardiovascular disease: are women with low socioeconomic status at high risk?


BACKGROUND: Cardiovascular disease is still portrayed as a typical male disease, and men are more often submitted to invasive procedures or referred earlier. AIM: To explore sex differences in morbidity and referral patterns in cardiovascular disease in general practice, and the role of age and socioeconomic status. METHOD: Data were obtained from a continuous morbidity registration project in the Netherlands from 1986 to 1995 in which 12,000 patients were followed over 10 years. The effects of sex, age, and socioeconomic status on morbidity of cardiovascular disease and the referral patterns were established. RESULTS: The sex difference in morbidity becomes smaller with increasing age. Morbidity was highest in the lower socioeconomic status in general and for angina pectoris in particular. Women with angina pectoris with low socioeconomic status have a relative risk of 2.24 (CI = 1.17-3.26) compared with women with high socioeconomic status. In men, no significant difference was found between the socioeconomic status groups. For angina pectoris the sex difference in referral to the specialist was most significant: 50.6% and 26.6% (P = 0.002) for men and women respectively. CONCLUSION: For women, low socioeconomic status was associated with relatively higher morbidity of angina pectoris and myocardial infarction than for men. Women are less likely to be referred than men are, in particular for angina pectoris.

Full Text

The Full Text of this article is available as a PDF (43K).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Wenger NK, Speroff L, Packard B. Cardiovascular health and disease in women. N Engl J Med. 1993 Jul 22;329(4):247–256. [PubMed]
  • Bickell NA, Pieper KS, Lee KL, Mark DB, Glower DD, Pryor DB, Califf RM. Referral patterns for coronary artery disease treatment: gender bias or good clinical judgment? Ann Intern Med. 1992 May 15;116(10):791–797. [PubMed]
  • Khan SS, Nessim S, Gray R, Czer LS, Chaux A, Matloff J. Increased mortality of women in coronary artery bypass surgery: evidence for referral bias. Ann Intern Med. 1990 Apr 15;112(8):561–567. [PubMed]
  • Van de Lisdonk EH, Van Weel C. New referrals, a decreasing phenomenon in 1971-94: analysis of registry data in the Netherlands. BMJ. 1996 Sep 7;313(7057):602–602. [PMC free article] [PubMed]
  • Gijsbers van Wijk CM, Kolk AM, van den Bosch WJ, van den Hoogen HJ. Male and female health problems in general practice: the differential impact of social position and social roles. Soc Sci Med. 1995 Mar;40(5):597–611. [PubMed]
  • Stoverinck MJ, Lagro-Janssen AL, Weel CV. Sex differences in health problems, diagnostic testing, and referral in primary care. J Fam Pract. 1996 Dec;43(6):567–576. [PubMed]
  • Kannel WB. Hazards, risks, and threats of heart disease from the early stages to symptomatic coronary heart disease and cardiac failure. Cardiovasc Drugs Ther. 1997 May;11 (Suppl 1):199–212. [PubMed]
  • Matthews KA, Meilahn E, Kuller LH, Kelsey SF, Caggiula AW, Wing RR. Menopause and risk factors for coronary heart disease. N Engl J Med. 1989 Sep 7;321(10):641–646. [PubMed]
  • Jacobsen BK, Thelle DS. Risk factors for coronary heart disease and level of education. The Tromsø Heart Study. Am J Epidemiol. 1988 May;127(5):923–932. [PubMed]
  • Brezinka V, Kittel F. Psychosocial factors of coronary heart disease in women: a review. Soc Sci Med. 1996 May;42(10):1351–1365. [PubMed]
  • Heller RF, Williams H, Sittampalam Y. Social class and ischaemic heart disease: use of the male:female ratio to identify possible occupational hazards. J Epidemiol Community Health. 1984 Sep;38(3):198–202. [PMC free article] [PubMed]
  • Haynes SG, Feinleib M. Women, work and coronary heart disease: prospective findings from the Framingham heart study. Am J Public Health. 1980 Feb;70(2):133–141. [PMC free article] [PubMed]
  • Marmot MG, Bosma H, Hemingway H, Brunner E, Stansfeld S. Contribution of job control and other risk factors to social variations in coronary heart disease incidence. Lancet. 1997 Jul 26;350(9073):235–239. [PubMed]
  • Chandola T. Social inequality in coronary heart disease: a comparison of occupational classifications. Soc Sci Med. 1998 Aug;47(4):525–533. [PubMed]

Articles from The British Journal of General Practice are provided here courtesy of Royal College of General Practitioners


Related citations in PubMed

See reviews...See all...

Cited by other articles in PMC

See all...


  • MedGen
    Related information in MedGen
  • PubMed
    PubMed citations for these articles

Recent Activity

Your browsing activity is empty.

Activity recording is turned off.

Turn recording back on

See more...