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Gender differences in the utilisation of surgery for congenital heart disease in India
  1. Sivasubramanian Ramakrishnan1,
  2. Rohan Khera2,
  3. Snigdha Jain2,
  4. Anita Saxena1,
  5. Suparna Kailash3,
  6. Ganesan Karthikeyan1,
  7. Shyam S Kothari1,
  8. Rajnish Juneja1,
  9. Balram Bhargava1,
  10. Mani Kalaivani4,
  11. Manju Mehta3,
  12. Vinay K Bahl1,
  13. Balram Airan5
  1. 1Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
  2. 2Medical students, All India Institute of Medical Sciences, New Delhi, India
  3. 3Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
  4. 4Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
  5. 5Department of Cardio-thoracic Surgery, All India Institute of Medical Sciences, New Delhi, India
  1. Correspondence to Dr S Ramakrishnan, Department of Cardiology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110 029, India; ramakgmc{at}


Background Corrective surgery for congenital heart disease may be life-saving, but its utilisation depends upon several social and economic factors. Girls with cardiac defects may not receive equitable care in India, but this has not been systematically studied.

Methods In this prospective study, parents or guardians of 405 consecutive children aged up to 12 years (mean±SD age 3.43±3.44 years; 271 boys) who had been advised to undergo elective paediatric cardiac surgery were interviewed using a validated questionnaire. The status of the patients was reviewed after a year and the factors associated with non-compliance with treatment were analysed. In a qualitative sub-study the parents of 20 children who had not undergone surgery were interviewed. Qualitative data were analysed using an inductive analytical approach.

Results Of the 405 patients studied, 44% (59/134) of girls had undergone surgery at 1 year compared with 70% (189/271) of boys (χ2=24.97; p<0.001). Independent predictors for non-compliance with surgery included female gender (OR 3.46, 95% CI −2.06 to 5.80; p<0.0001), lower socioeconomic classes (lower-middle: OR 18.62, 95% CI −2.14 to 161.8, p=0.008; upper-lower: OR 34.27, 95% CI −3.72 to 316.0, p=0.002) and higher cost of surgery (OR 1.92, 95% CI −1.06 to 3.47, p=0.03). In the in-depth interviews, apprehensions about future matrimonial prospects of girls and lack of social support emerged as the major factors responsible for delays in undergoing surgery.

Conclusions Female gender is an important determinant of non-compliance with paediatric cardiac surgery. Deep-seated social factors underlie this gender bias.

  • Surgery-paediatric
  • paediatric surgery
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  • See Editorial, p 1897

  • Competing interests None.

  • Patient consent Obtained.

  • Ethics approval This study was conducted with the approval of the All India Institute of Medical Sciences, New Delhi.

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

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