BMJ  1993;306:1164-1166 (1 May), doi:10.1136/bmj.306.6886.1164

Coronary artery surgery: are women discriminated against?

Health Services Research Unit, London School of Hygiene and Tropical Medicine.

OBJECTIVE--To determine whether the sex differences in access to cardiac surgery observed in the United States exist in the United Kingdom. DESIGN--Retrospective analysis of routinely collected data. SETTING--South West Thames and North West Thames regional health authorities. SUBJECTS--8564 patients discharged from hospital with a principal diagnosis of coronary heart disease in 1987-8 in South West Thames region and 15243 discharges in North West Thames region in 1990-1. MAIN OUTCOME MEASURES--Performance of angiography or coronary artery bypass surgery. RESULTS--In all age groups and among patients with a principal diagnosis of either angina or chronic ischaemia men were significantly more likely than women to undergo revascularisation in both regions. Using multiple logistic regression to control for potential clinical and demographic confounders, the male to female odds ratio for revascularisation among all cases was 1.59 (95% confidence interval 1.25 to 2.03) in South West Thames region and 1.47 (1.32 to 1.63) in North West Thames region. CONCLUSION--There appears to be a systematic difference in the treatment received by men and women in the United Kingdom. The reasons for this are uncertain.

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