Correa-de-Araujo Rosaly, Stevens Beth, Moy Ernest, Nilasena David, Chesley Francis, McDermott Kelly
Agency for Healthcare Research and Quality, Rockville, Maryland 20850, USA.
Womens Health Issues. 2006 Mar-Apr;16(2):44-55. doi: 10.1016/j.whi.2005.04.003.
This paper provides important insights on gender differences across racial and ethnic groups in a Medicare population in terms of the quality of care received for acute myocardial infarction (AMI) and congestive heart failure (CHF) in association with diabetes or hypertension/end-stage renal disease (ESRD). Both race/ethnicity and gender are associated with differences in the diagnostic evaluation and treatment of Medicare recipients with these conditions. In the AMI group, non-Hispanic Black and Hispanic patients of both genders were less likely to receive aspirin or beta-blockers than non-Hispanic Whites. These differences persisted for Hispanic women and men even when they presented with ESRD or diabetes. Rates for smoking cessation counseling were among the lowest among non-Hispanic Blacks and Hispanics with AMI-diabetes and non-Hispanic blacks with AMI-hypertension/ESRD. Gender comparisons within racial groups for the AMI and AMI-diabetes groups show that among non-Hispanic Whites, women were less likely to receive aspirin and beta-blockers. No gender differences were noted among non-Hispanic Black and Hispanic Medicare recipients. In the CHF group, Hispanics were the racial/ethnic group least likely to have an assessment of left ventricular function (LVF), even if they had diabetes and had lower rates of angiotensin-converting enzyme inhibitor therapy or even if they had combined CHF-hypertension/ESRD. Gender comparisons in both the CHF and CHF-hypertension/ESRD groups show that non-Hispanic White women were less likely to have an LVF assessment than non-Hispanic White men. Among all subjects, having comorbidities with AMI was not associated with higher markers of quality cardiovascular care. Closing the many gaps in cardiovascular care must target the specific needs of women and men across racial and ethnic groups.
本文提供了关于医疗保险人群中不同种族和族裔群体之间性别差异的重要见解，这些差异涉及与糖尿病或高血压/终末期肾病（ESRD）相关的急性心肌梗死（AMI）和充血性心力衰竭（CHF）的护理质量。种族/族裔和性别都与患有这些疾病的医疗保险受益人的诊断评估和治疗差异有关。在AMI组中，与非西班牙裔白人相比，非西班牙裔黑人和西班牙裔的男女患者服用阿司匹林或β受体阻滞剂的可能性较小。即使西班牙裔女性和男性患有ESRD或糖尿病，这些差异仍然存在。在患有AMI-糖尿病的非西班牙裔黑人和西班牙裔以及患有AMI-高血压/ESRD的非西班牙裔黑人中，戒烟咨询率是最低的。AMI组和AMI-糖尿病组种族群体内部的性别比较显示，在非西班牙裔白人中，女性服用阿司匹林和β受体阻滞剂的可能性较小。在非西班牙裔黑人和西班牙裔医疗保险受益人中未发现性别差异。在CHF组中，西班牙裔是最不可能进行左心室功能（LVF）评估的种族/族裔群体，即使他们患有糖尿病且血管紧张素转换酶抑制剂治疗率较低，或者即使他们患有CHF-高血压/ESRD。CHF组和CHF-高血压/ESRD组的性别比较显示，与非西班牙裔白人男性相比，非西班牙裔白人女性进行LVF评估的可能性较小。在所有受试者中，患有AMI合并症与更高的心血管护理质量指标无关。缩小心血管护理中的诸多差距必须针对不同种族和族裔群体中男性和女性的特定需求。
