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Med Care. 2000 Apr;38(4):354-65.

Relation of gender and health insurance to cardiovascular procedure use in persons with progression of chronic renal disease.

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1
Robert Wood Johnson Clinical Scholars Program, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. gdaumit@jhmi.edu

Abstract

BACKGROUND:

Women often are less likely than men to receive diagnostic and therapeutic invasive procedures for coronary disease.

OBJECTIVE:

To examine the relation between gender, health insurance, and access to cardiovascular procedures over time in persons with chronic illness.

RESEARCH DESIGN:

Seven-year longitudinal analyses in a cohort from the United States Renal Data System.

SUBJECTS:

National random sample of women and men who progressed to end-stage renal disease (ESRD) in 1986 to 1987 and were treated at 303 dialysis facilities (n = 4,987).

MEASURES:

Medical history and utilization records, physical examination, and laboratory data.

MAIN OUTCOME MEASURES:

Receipt of a coronary catheterization or revascularization procedure before (baseline) and after (follow-up) the development of ESRD and acquisition of Medicare, adjusted for clinical and socioeconomic variables.

RESULTS:

At baseline, 5.2% of women and 9.2% of men had undergone a cardiac procedure; the odds of women receiving a procedure were one third lower than for men (adjusted odds ratio 0.66 [95% CI 0.49-0.88]). During follow-up, women were just as likely as men to undergo a procedure (adjusted odds ratio 0.94 [95% CI 0.74-1.20]). Compared with men with baseline private insurance, men and women with other and no insurance had 34% to 81% lower odds of receiving procedures at baseline. Women with private insurance had 42% lower odds of having a procedure at baseline compared with men (adjusted odds ratio 0.58 [95% CI 0.42-0.78]) but had the same odds at follow-up (adjusted odds ratio 1.09 [95% CI 0.82-1.45]). At follow-up, gender differences in procedure use were eliminated for groups with baseline Medicaid or no insurance.

CONCLUSIONS:

Overall gender differences in cardiac procedure use were narrowed markedly after progression of a serious illness, the assurance of health insurance, and entry into a comprehensive care system. Gender disparities in procedure use for different baseline insurance groups were largely equalized in follow-up. These findings suggest that provision of insurance with disease-managed care for a chronic disease can provide equalized access to care for women.

PMID:
10752967
[Indexed for MEDLINE]
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