Roger V L, Farkouh M E, Weston S A, Reeder G S, Jacobsen S J, Zinsmeister A R, Yawn B P, Kopecky S L, Gabriel S E
Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic and Mayo Foundation, Rochester, Minn 55905, USA.
JAMA. 2000 Feb 2;283(5):646-52. doi: 10.1001/jama.283.5.646.
The existence of sex bias in the delivery of cardiac care is controversial, and little is known about the association between sex and delivery of care and outcomes at an early point in the diagnostic sequence, such as when patients present for the evaluation of chest pain.
To test the hypothesis that female sex is negatively associated with care delivered to and outcomes of persons diagnosed as having unstable angina.
Inception population-based cohort study with an average of 6 years of follow-up.
Emergency departments (EDs) in Olmsted County, Minnesota.
A total of 2271 Olmsted County residents (1306 men and 965 women) who presented to the ED for the first time with symptoms meeting criteria for unstable angina between 1985 and 1992.
Use of cardiac procedures within 90 days of ED visit, overall mortality, and cardiac events (cardiac death, nonfatal myocardial infarction, nonfatal cardiac arrest, and congestive heart failure), compared by sex and Agency for Health Care Policy and Research cardiovascular risk category (low, intermediate, or high).
Women were older (P<.001), more likely to have a history of hypertension (P = .001), and less likely to present with typical angina (P = .004) than men. Men were more likely than women to undergo noninvasive cardiac tests (relative risk [RR], 1.27; 95% confidence interval [CI], 1.14-1.40) as well as invasive cardiac procedures (RR, 1.72; 95% CI, 1.51-1.97). After adjustment, male sex was associated with a 24% increase in the use of cardiac procedures. Survival of both men and women in the high and intermediate risk categories was significantly lower than expected per the general population (P<.001). Women had a worse outcome than men, but after multivariate adjustment, male sex was associated with a trend toward an increase in the risk of death (RR, 1.23; 95% CI, 0.99-1.54) and significantly associated with increased risk of cardiac events (RR, 1.21; 95% CI, 1.03-1.42).
Our population-based data indicate that after an ED visit for symptoms of unstable angina, the use of cardiac procedures was lower in women, but after taking into account baseline characteristics, men experienced worse outcomes.
心脏护理服务中存在性别偏见这一情况存在争议，而且对于在诊断流程的早期阶段，比如患者因胸痛前来评估时，性别与护理服务的提供以及治疗结果之间的关联，人们了解甚少。
检验女性与被诊断为不稳定型心绞痛患者所接受的护理服务及治疗结果呈负相关这一假设。
基于初始人群的队列研究，平均随访6年。
明尼苏达州奥尔姆斯特德县的急诊科。
1985年至1992年间首次因出现符合不稳定型心绞痛标准症状而到急诊科就诊的2271名奥尔姆斯特德县居民（1306名男性和965名女性）。
根据性别以及医疗保健政策与研究机构的心血管风险类别（低、中或高），比较急诊就诊后90天内心脏检查的使用情况、总体死亡率以及心脏事件（心源性死亡、非致命性心肌梗死、非致命性心脏骤停和充血性心力衰竭）。
与男性相比，女性年龄更大（P<0.001），更有可能有高血压病史（P = 0.001），且出现典型心绞痛的可能性更小（P = 0.004）。男性比女性更有可能接受非侵入性心脏检查（相对风险[RR]，1.27；95%置信区间[CI]，1.14 - 1.40）以及侵入性心脏检查（RR，1.72；95%CI，1.51 - 1.97）。调整后，男性与心脏检查使用增加24%相关。高风险和中风险类别的男性和女性的生存率均显著低于一般人群预期（P<0.001）。女性的治疗结果比男性更差，但经过多变量调整后，男性与死亡风险增加趋势相关（RR，1.23；95%CI，0.99 - 1.54），且与心脏事件风险增加显著相关（RR，1.21；95%CI，1.03 - 1.42）。
我们基于人群的数据表明，因不稳定型心绞痛症状到急诊科就诊后，女性心脏检查的使用较少，但在考虑基线特征后，男性的治疗结果更差。
