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Healthcare delivery, economics and global health
Original article
Gender inequalities in cardiovascular risk factor assessment and management in primary healthcare
  1. Karice K Hyun1,
  2. Julie Redfern1,
  3. Anushka Patel1,
  4. David Peiris1,
  5. David Brieger2,
  6. David Sullivan3,
  7. Mark Harris4,
  8. Tim Usherwood1,5,
  9. Stephen MacMahon1,6,
  10. Marilyn Lyford1,7,
  11. Mark Woodward1,6
  1. 1The George Institute for Global Health, Sydney Medical School, University of Sydney, Sydney, Australia
  2. 2Department of Cardiology, Concord Hospital, University of Sydney, Sydney, Australia
  3. 3Department of Chemical Pathology, Royal Prince Alfred Hospital, Sydney, Australia
  4. 4Centre for Primary Health Care and Equity, University of New South Wales, Sydney, Australia
  5. 5Sydney Medical School Westmead, University of Sydney, Sydney, Australia
  6. 6The George Institute for Global Health, University of Oxford, Oxford, UK
  7. 7WA Centre for Rural Health, University of Western Australia, Perth, Australia
  1. Correspondence to Karice K Hyun, The George Institute for Global Health, Sydney Medical School, University of Sydney, Level 10, King George V Building, 83-117 Missenden Rd, Camperdown, NSW 2050, Australia; khyun{at}georgeinstitute.org.au

Abstract

Objectives To quantify contemporary differences in cardiovascular disease (CVD) risk factor assessment and management between women and men in Australian primary healthcare services.

Methods Records of routinely attending patients were sampled from 60 Australian primary healthcare services in 2012 for the Treatment of Cardiovascular Risk using Electronic Decision Support study. Multivariable logistic regression models were used to compare the rate of CVD risk factor assessment and recommended medication prescriptions, by gender.

Results Of 53 085 patients, 58% were female. Adjusting for demographic and clinical characteristics, women were less likely to have sufficient risk factors measured for CVD risk assessment (OR (95% CI): 0.88 (0.81 to 0.96)). Among 13 294 patients (47% women) in the CVD/high CVD risk subgroup, the adjusted odds of prescription of guideline-recommended medications were greater for women than men: 1.12 (1.01 to 1.23). However, there was heterogeneity by age (p <0.001), women in the CVD/high CVD risk subgroup aged 35–54 years were less likely to be prescribed the medications (0.63 (0.52 to 0.77)), and women in the CVD/high CVD risk subgroup aged ≥65 years were more likely to be prescribed the medications (1.34 (1.17 to 1.54)) than their male counterparts.

Conclusions Women attending primary healthcare services in Australia were less likely than men to have risk factors measured and recorded such that absolute CVD risk can be assessed. For those with, or at high risk of, CVD, the prescription of appropriate preventive medications was more frequent in older women, but less frequent in younger women, compared with their male counterparts.

Trial registration number 12611000478910, Pre-results.

https://doi.org/10.1136/heartjnl-2016-310216

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    Footnotes

    • Contributors KKH, MW, JR and DP participated in the design of the study. KKH performed the statistical analysis. KKH, MW, JR, DP and AP participated in the interpretation of the results. KKH drafted and all authors reviewed the manuscript. All authors read and approved the final manuscript.

    • Funding The National Health and Medical Research Council of Australia and the New South Wales Department of Health funded TORPEDO. KKH is funded by the University of Sydney Postgraduate Award. DP is supported by a National Health and Medical Research Council (NHMRC) postdoctoral fellowship (1054754). AP is supported by an NHMRC Senior Research Fellowship (632938). JR is funded by a NHMRC Career Development Fellowship (1061793) cofunded with a National Heart Foundation Future Fellowship (G160523) and MW is supported by a NHMRC Principal Research Fellowship.

    • Disclaimer Neither institutions had any role in the design and conduct of the study; collection, management, analysis and interpretation of the data; preparation, review or approval of the article or decision to submit the article for publication.

    • Competing interests None declared.

    • Ethics approval The study was approved by the University of Sydney Human Research Ethics Committee and the Aboriginal Health and Medical Research Council of New South Wales Human Research Ethics Committee. Individual consent waiver was granted, given that data collection was based on deidentified extracts from the electronic health record system.

    • Provenance and peer review Not commissioned; externally peer reviewed.

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