BMJ 2001;322:832 ( 7 April )

Primary care

Sex inequalities in ischaemic heart disease in general practice: cross sectional survey

Julia Hippisley-Cox, senior lecturer in general practice, a Mike Pringle, professor of general practice, a Nicola Crown, researcher, b Andy Meal, lecturer, c Alison Wynn, researcher in general practice. a

a Division of General Practice, Nottingham University, Nottingham NG7 2RD, b Collingham Medical Centre, High Street, Collingham NG23 7LB, c School of Nursing, Medical School, Queen's Medical Centre, Nottingham NG7 2UH

Correspondence to: J Hippisley-Cox julia.hippisley-cox{at}nottingham.ac.uk

Objective: To study differences in treatment for men and women with ischaemic heart disease by using standards defined in England's national service framework for coronary artery disease.
Design: Cross sectional survey using routinely collected data.
Setting: 18 practices in 18 primary care groups in Trent Region.
Subjects: 5891 men and women aged over 35 years with a diagnosis of ischaemic heart disease or prescription for nitrates recorded on computer.
Main outcome measure: Difference in the proportion of men and women with ischaemic heart disease and taking lipid lowering treatment.
Results: Women were less likely than men to have a recording of body mass index (79% (2197/2783) v 82% (2552/3102), P=0.002), smoking (86% (2386) v 89% (2779), P<0.0001), and blood pressure (95% (2643) v 96% (2986), P=0.04). Women were also less likely to have a recording of fasting cholesterol concentration (35% (968) v 50% (1550), P<0.0001) but were more likely to be obese (25% (558/2197) v 20% (514/2552), P<0.0001) and have their most recently recorded blood pressure value over the recommended 140/85 mm Hg (60% (1598/2643) v 52% (1553/2986), P<0.0001). Although a higher proportion of women had a raised serum cholesterol concentration (77% (749/968) v 67% (1043/1550), P<0.0001), men were more likely to take aspirin (76% (2358) v 71% (1979), P<0.0001), have a recorded diagnosis of hyperlipidaemia (13% (418) v 10% (274), P<0.0001), and be prescribed lipid lowering drugs (31% (973) v 21% (596), P<0.0001). These differences remained despite adjustments for the practice where the patient is registered, age, smoking status, obesity, diabetes, and hypertension.
Conclusion: The results suggest a systematic bias towards men compared with women in terms of secondary prevention of ischaemic heart disease.


What is already known on this topic
England's national service framework for coronary artery disease requires general practitioners to identify and treat patients at high risk of ischaemic heart disease

Substantial evidence of sex inequality for this disease exists for access to secondary care less but less is known about equity for its management in general practice

What this study adds
Among patients with ischaemic heart disease, men were more likely than women to have cardiovascular risk factors and serum cholesterol concentration recorded on computer

A higher proportion of women, however, had raised cholesterol concentrations recorded on computer, but more men were treated with lipid lowering drugs

The results suggest a systematic bias towards men compared with women in terms of secondary prevention of ischaemic heart disease.



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Rapid Responses:

Read all Rapid Responses

Sex inequalities in ischaemic heart disease in general practice
P J Moorhouse
bmj.com, 18 Apr 2001 [Full text]
Re: Sex inequalities in ischaemic heart disease in general practice
Sarah Wild
bmj.com, 20 Apr 2001 [Full text]
Reports of gender bias in use of CHD care may be premature
Rosalind Raine
bmj.com, 26 Apr 2001 [Full text]
Sex inequalities in ischaemic heart disease in general practice
T J Ramsbottom, et al.
bmj.com, 2 May 2001 [Full text]
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