Aaronson K D, Schwartz J S, Goin J E, Mancini D M
Department of Medicine, Columbia University College of Physicians and Surgeons, Philadelphia, USA.
Circulation. 1995 Jun 1;91(11):2753-61. doi: 10.1161/01.cir.91.11.2753.
The overwhelming majority of cardiac transplant recipients are men. This can be partially explained by the earlier age at which heart failure develops in men. However, an underrepresentation of women also may reflect physician referral or selection biases or differences in patients' access to or acceptance of heart transplantation.
We investigated whether sex bias occurred in the transplant candidate selection process at a single cardiac transplant center. We prospectively evaluated 386 individuals < 70 years of age (295 men, 91 women) referred for management of moderate to severe heart failure and/or cardiac transplant evaluation. Age, race, sex, heart failure type, New York Heart Association class, left ventricular ejection fraction, peak exercise oxygen consumption, disease duration, resting hemodynamic measurements, comorbidity index score, health insurance coverage, and estimated household income were recorded. For patients not accepted for transplantation, the reason for rejection was also obtained. Univariable and multivariable (logistic regression) analyses were performed comparing men and women and patients accepted and those not accepted for cardiac transplantation. Female sex was independently associated with rejection for cardiac transplantation (odds ratio, 2.57; P = .01). However, the reason for rejection (odds ratio, 2.57; P = .01). However, the reason for rejection was more likely to be patient self-refusal for women than for men (29% versus 9%), and female sex was independently associated with patient self-refusal (odds ratio, 4.68; P = .003). When patients who refused transplant were reclassified as accepted for transplant, female sex was no longer associated with nonacceptance. However, lower patient income was associated with nonacceptance for transplant.
We found no evidence of sex bias in the selection of cardiac transplant recipients at our center. These findings suggest that the underrepresentation of women among cardiac transplant recipients may result, in part, from a sex difference in treatment preference, with a decreased willingness of women to undergo transplantation. The reasons for the difference in acceptance rates between men and women need to be elucidated.
绝大多数心脏移植受者为男性。这部分可以通过男性心力衰竭发病年龄较早来解释。然而，女性比例偏低也可能反映出医生转诊或选择偏见，或患者在获得心脏移植或接受心脏移植方面的差异。
我们调查了在一家心脏移植中心的移植候选者选择过程中是否存在性别偏见。我们前瞻性地评估了386名70岁以下的个体（295名男性，91名女性），他们因中度至重度心力衰竭的管理和/或心脏移植评估而被转诊。记录了年龄、种族、性别、心力衰竭类型、纽约心脏协会分级、左心室射血分数、峰值运动耗氧量、疾病持续时间、静息血流动力学测量、合并症指数评分、医疗保险覆盖范围和估计家庭收入。对于未被接受移植的患者，也获取了拒绝的原因。进行了单变量和多变量（逻辑回归）分析，比较男性和女性以及接受心脏移植和未接受心脏移植的患者。女性性别与心脏移植被拒独立相关（比值比，2.57；P = 0.01）。然而，拒绝的原因（比值比，2.57；P = 0.01）。然而，女性拒绝移植的原因更可能是患者自我拒绝，而非男性（29%对9%），并且女性性别与患者自我拒绝独立相关（比值比，4.68；P = 0.003）。当拒绝移植的患者被重新分类为接受移植时，女性性别不再与不被接受相关。然而，患者收入较低与不被接受移植相关。
我们在本中心未发现心脏移植受者选择中存在性别偏见的证据。这些发现表明，心脏移植受者中女性比例偏低可能部分是由于治疗偏好的性别差异，女性接受移植的意愿降低。男女接受率差异的原因需要阐明。
