1
|
Ferreruela IL, Azuara BO, Fumanal SM, Hernández MJR, Aguilar-Palacio I. Gender inequalities in secondary prevention of cardiovascular disease: a scoping review. Int J Equity Health 2024; 23:146. [PMID: 39044250 PMCID: PMC11264402 DOI: 10.1186/s12939-024-02230-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Accepted: 07/09/2024] [Indexed: 07/25/2024] Open
Abstract
BACKGROUND Despite significant progress in cardiovascular disease (CVD) management, it remains a public health priority and a global challenge. Within the disease process, health care after a cardiovascular event (secondary prevention) is essential to prevent recurrences. Nonetheless, evidence has suggested the existence of gender disparities in CVD management, leaving women in a vulnerable situation. The objective of this study is to identify all available evidence on the existence of gender differences in health care attention after a major adverse cardiovascular event. METHODS A scoping review following the structure of PRISMA-ScR was conducted. To define the inclusion criteria, we used Joanna Briggs Institute (JBI) population, concept, context framework for scoping reviews. A systematic search was performed in MEDLINE (PubMed), EMBASE and Cochrane. The methods of this review are registered in the International Platform of Registered Systematic Review and Meta-Analysis Protocols (INPLASY) (INPLASY202350084). RESULTS The initial search retrieved 3,322 studies. 26 articles were identified manually. After the reviewing process, 93 articles were finally included. The main intervention studied was the pharmacological treatment received (n = 61, 66%), distantly followed by guideline-recommended care (n = 26, 28%) and cardiac rehabilitation (CR) referral (n = 16)". Literature described gender differences in care and management of secondary prevention of CVD. Women were less frequently treated with guideline-recommended medications and seem more likely to be non-adherent. When analysing guideline recommendations, women were more likely to make dietary changes, however, men were more likely to increase physical activity. Studies also showed that women had lower rates of risk factor testing and cholesterol goals attainment. Female sex was associated with lower rates of cardiac rehabilitation referral and participation. CONCLUSIONS This review allowed us to compile knowledge on the existence of gender inequalities on the secondary prevention of CVD. Additional research is required to delve into various factors influencing therapeutic disparities, referral and non-participation in CR programs, among other aspects, in order to improve existing knowledge about the management and treatment of CVD in men and women. This approach is crucial to ensure the most equitable and effective attention to this issue.
Collapse
Affiliation(s)
- Irene López Ferreruela
- Internal Medicine Service, Miguel Servet University Hospital, Saragossa, Spain.
- GRISSA Research Group. IIS Aragón, Aragon Health Sciences Institute, Saragossa, Spain.
- Faculty of Medicine, University of Zaragoza, Saragossa, Spain.
| | - Blanca Obón Azuara
- Intensive Medicine Service, Lozano Blesa University Hospital, Saragossa, Spain
- GRISSA Research Group. IIS Aragón, Aragon Health Sciences Institute, Saragossa, Spain
| | - Sara Malo Fumanal
- GRISSA Research Group. IIS Aragón, Aragon Health Sciences Institute, Saragossa, Spain
- Faculty of Medicine, University of Zaragoza, Saragossa, Spain
| | - María José Rabanaque Hernández
- GRISSA Research Group. IIS Aragón, Aragon Health Sciences Institute, Saragossa, Spain
- Faculty of Medicine, University of Zaragoza, Saragossa, Spain
| | - Isabel Aguilar-Palacio
- GRISSA Research Group. IIS Aragón, Aragon Health Sciences Institute, Saragossa, Spain
- Faculty of Medicine, University of Zaragoza, Saragossa, Spain
| |
Collapse
|
2
|
Boccara F, Sabouret P, Boileau C, Georges JL, Leclercq C, Lesnik P, Bruckert E. Establishing a multi-specialty consensus in the clinical need for hypercholesterolemia management and its implication for patients access to innovative therapies. Panminerva Med 2024; 66:18-26. [PMID: 37851332 DOI: 10.23736/s0031-0808.23.04999-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
BACKGROUND Increased level of blood LDL-C has a causal and cumulative effect on advancing atherosclerotic cardiovascular diseases (ASCVD). European guidelines for treating high LDL-C levels have been recently updated. However, in France, several challenges (e.g., physician and patient awareness, healthcare management) limit the application of management guidelines. The aim of this study was to understand the current opinions and perceived unmet clinical needs in recognising and managing hypercholesterolemia as an ASCVD risk factor, and to explore consensus around factors that support the effective management of elevated LDL-C. METHODS An expert group of cardiologists, endocrinologists, biology/genetics researchers, and a health technology assessments expert, from France was convened. The current management of hypercholesterolemia and barriers to achieving LDL-C goals in France were discussed and 44 statements were developed. Wider consensus was assessed by sending the statements as a 4-point Likert Scale questionnaire to cardiologists and endocrinologists across France. The consensus threshold was defined as ≥75%. RESULTS A total of 101 responses were received. Consensus was very high (>90%) in 25 (57%) statements, high (≥75%) in 18 (41%) statements and was not achieved (<75%) only in 1 (2%) of statements. Overall, 43 statements achieved consensus. CONCLUSIONS Based on consensus levels, key recommendations for improving current guidelines and approaches to care have been developed. Implementation of these recommendations will lead to better concordance with international treatment guidelines and increase levels of education for healthcare practitioners and patients. In turn, this will improve the available treatment pathways for cardiovascular diseases, potentially creating improved patient outcomes in the future.
Collapse
Affiliation(s)
- Franck Boccara
- Department of Cardiology, Saint-Antoine Research Center, Institut National de la Santé et de la Recherche Médicale (INSERM) UMR S938, Saint-Antoine Hospital, Hôpitaux de l'Est Parisien, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne University, Paris, France -
| | - Pierre Sabouret
- Service of Cardiology, Institute of Cardiology, Pitié-Salpêtrière University Hospital, Sorbonne University, Paris, France
| | - Catherine Boileau
- Department of Genetics, LVTS - Institut National de la Santé et de la Recherche Médicale (INSERM) U1148, Bichat-Claude Bernard Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris Cité, Paris, France
| | - Jean-Louis Georges
- Service of Cardiology, Center Hospitalier de Versailles, Le Chesnay, France
- Annales de Cardiologie et Angéiologie, Elsevier Masson SAS, Issy les Moulineaux, France
| | - Christophe Leclercq
- Service of Cardiology, Rennes University Hospital, University of Rennes, Rennes, France
| | - Philippe Lesnik
- Institut National de la Santé et de la Recherche Médicale (INSERM) UMR_S 1166, Pitié-Salpêtrière University Hospital, Sorbonne University, Paris, France
| | | |
Collapse
|
3
|
Brown CJ, Chang LS, Hosomura N, Malmasi S, Morrison F, Shubina M, Lan Z, Turchin A. Assessment of Sex Disparities in Nonacceptance of Statin Therapy and Low-Density Lipoprotein Cholesterol Levels Among Patients at High Cardiovascular Risk. JAMA Netw Open 2023; 6:e231047. [PMID: 36853604 PMCID: PMC9975905 DOI: 10.1001/jamanetworkopen.2023.1047] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/01/2023] Open
Abstract
IMPORTANCE Many patients at high cardiovascular risk-women more commonly than men-are not receiving statins. Anecdotally, it is common for patients to not accept statin therapy recommendations by their clinicians. However, population-based data on nonacceptance of statin therapy by patients are lacking. OBJECTIVES To evaluate sex disparities in nonacceptance of statin therapy and assess their association with low-density lipoprotein (LDL) cholesterol control. DESIGN, SETTING, AND PARTICIPANTS A retrospective cohort study was conducted from January 1, 2019, to December 31, 2022, of statin-naive patients with atherosclerotic cardiovascular disease, diabetes, or LDL cholesterol levels of 190 mg/dL (to convert to millimoles per liter, multiply by 0.0259) or more who were treated at Mass General Brigham between January 1, 2000, and December 31, 2018. EXPOSURE Recommendation of statin therapy by the patient's clinician, ascertained from the combination of electronic health record prescription data and natural language processing of electronic clinician notes. MAIN OUTCOMES AND MEASURES Time to achieve an LDL cholesterol level of less than 100 mg/dL. RESULTS Of 24 212 study patients (mean [SD] age, 58.8 [13.0] years; 12 294 women [50.8%]), 5308 (21.9%) did not accept the initial recommendation of statin therapy. Nonacceptance of statin therapy was more common among women than men (24.1% [2957 of 12 294] vs 19.7% [2351 of 11 918]; P < .001) and was similarly higher in every subgroup in the analysis stratified by comorbidities. In multivariable analysis, female sex was associated with lower odds of statin therapy acceptance (0.82 [95% CI, 0.78-0.88]). Patients who did vs did not accept a statin therapy recommendation achieved an LDL cholesterol level of less than 100 mg/dL over a median of 1.5 years (IQR, 0.4-5.5 years) vs 4.4 years (IQR, 1.3-11.1 years) (P < .001). In a multivariable analysis adjusted for demographic characteristics and comorbidities, nonacceptance of statin therapy was associated with a longer time to achieve an LDL cholesterol level of less than 100 mg/dL (hazard ratio, 0.57 [95% CI, 0.55-0.60]). CONCLUSIONS AND RELEVANCE This cohort study suggests that nonacceptance of a statin therapy recommendation was common among patients at high cardiovascular risk and was particularly common among women. It was associated with significantly higher LDL cholesterol levels, potentially increasing the risk for cardiovascular events. Further research is needed to understand the reasons for nonacceptance of statin therapy by patients and to develop methods to ensure that all patients receive optimal therapy in accordance with their preferences and priorities.
Collapse
Affiliation(s)
- C. Justin Brown
- Division of Endocrinology, Brigham and Women’s Hospital, Boston, Massachusetts
- Pharmacy Department, Tufts Medical Center, Boston, Massachusetts
| | - Lee-Shing Chang
- Division of Endocrinology, Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Naoshi Hosomura
- Division of Endocrinology, Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Shervin Malmasi
- Division of Endocrinology, Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
- Amazon.com Inc, Seattle, Washington
| | - Fritha Morrison
- Division of Endocrinology, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Maria Shubina
- Division of Endocrinology, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Zhou Lan
- Harvard Medical School, Boston, Massachusetts
- Center for Clinical Investigation, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Alexander Turchin
- Division of Endocrinology, Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
4
|
de Jong M, Peters SAE, de Ritter R, van der Kallen CJH, Sep SJS, Woodward M, Stehouwer CDA, Bots ML, Vos RC. Sex Disparities in Cardiovascular Risk Factor Assessment and Screening for Diabetes-Related Complications in Individuals With Diabetes: A Systematic Review. Front Endocrinol (Lausanne) 2021; 12:617902. [PMID: 33859615 PMCID: PMC8043152 DOI: 10.3389/fendo.2021.617902] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 02/11/2021] [Indexed: 11/24/2022] Open
Abstract
Background Insight in sex disparities in the detection of cardiovascular risk factors and diabetes-related complications may improve diabetes care. The aim of this systematic review is to study whether sex disparities exist in the assessment of cardiovascular risk factors and screening for diabetes-related complications. Methods PubMed was systematically searched up to April 2020, followed by manual reference screening and citations checks (snowballing) using Google Scholar. Observational studies were included if they reported on the assessment of cardiovascular risk factors (HbA1c, lipids, blood pressure, smoking status, or BMI) and/or screening for nephropathy, retinopathy, or performance of feet examinations, in men and women with diabetes separately. Studies adjusting their analyses for at least age, or when age was considered as a covariable but left out from the final analyses for various reasons (i.e. backward selection), were included for qualitative analyses. No meta-analyses were planned because substantial heterogeneity between studies was expected. A modified Newcastle-Ottawa Quality Assessment Scale for cohort studies was used to assess risk of bias. Results Overall, 81 studies were included. The majority of the included studies were from Europe or North America (84%).The number of individuals per study ranged from 200 to 3,135,019 and data were extracted from various data sources in a variety of settings. Screening rates varied considerably across studies. For example, screening rates for retinopathy ranged from 13% to 90%, with half the studies reporting screening rates less than 50%. Mixed findings were found regarding the presence, magnitude, and direction of sex disparities with regard to the assessment of cardiovascular risk factors and screening for diabetes-related complications, with some evidence suggesting that women, compared with men, may be more likely to receive retinopathy screening and less likely to receive foot exams. Conclusion Overall, no consistent pattern favoring men or women was found with regard to the assessment of cardiovascular risk factors and screening for diabetes-related complications, and screening rates can be improved for both sexes.
Collapse
Affiliation(s)
- Marit de Jong
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Sanne A. E. Peters
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
- The George Institute for Global Health, Imperial College London, London, United Kingdom
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Rianneke de Ritter
- Department of Internal Medicine, Maastricht University Medical Center, Maastricht, Netherlands
- CARIM Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, Netherlands
| | - Carla J. H. van der Kallen
- Department of Internal Medicine, Maastricht University Medical Center, Maastricht, Netherlands
- CARIM Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, Netherlands
| | - Simone J. S. Sep
- Department of Internal Medicine, Maastricht University Medical Center, Maastricht, Netherlands
- CARIM Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, Netherlands
- Centre of Expertise in Rehabilitation and Audiology, Adelante, Hoensbroek, Netherlands
| | - Mark Woodward
- The George Institute for Global Health, Imperial College London, London, United Kingdom
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD, United States
| | - Coen D. A. Stehouwer
- Department of Internal Medicine, Maastricht University Medical Center, Maastricht, Netherlands
- CARIM Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, Netherlands
| | - Michiel L. Bots
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Rimke C. Vos
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
- Department Public Health and Primary Care / LUMC-Campus The Hagua, Leiden University Medical Center, Hague, Netherlands
| |
Collapse
|
5
|
Blacher J, Gabet A, Vallée A, Ferrières J, Bruckert E, Farnier M, Olié V. Prevalence and management of hypercholesterolemia in France, the Esteban observational study. Medicine (Baltimore) 2020; 99:e23445. [PMID: 33327276 PMCID: PMC7738064 DOI: 10.1097/md.0000000000023445] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Hypercholesterolemia is a major risk factor for cardiovascular diseases. However, its management in everyday clinical practice is often suboptimal. The aims of the Esteban study were to estimate the prevalence of hypercholesterolemia and to describe its management in France in 2015.Esteban is a cross-sectional, publicly funded survey, representative of the French population. Data were collected using questionnaires and biological and clinical examinations in 3021 adults aged 18-74.The lipid-lowering treatments were obtained by matching the individual data of the subjects included in the Esteban survey with data from the Système national de données de santé. Hypercholesterolemia was defined as either a low density lipoprotein cholesterol value higher than the goal set in the European Society of Cardiology/European Atherosclerosis Society guidelines as a function of individual cardiovascular risk level, or at least 1 delivery of lipid-lowering treatment. Adherence was defined by the proportion of days covered by the lipid-lowering treatment in the 6 months preceding clinical examination. Prevalence of hypercholesterolemia in France was 23.3% (27.8% in men, 19.0% in women). Mean low density lipoprotein cholesterol was 3.38 mmol/l in French participants. Among them, 7.2% were treated (8.5% of men, 5.8% of women), while 16.1% of adults went untreated (19.3% of men, 13.2% of women). Only 29.7% of secondary prevention adults had a delivery of lipid-lowering treatments in the 6 months preceding clinical examination. Fewer than 1 in 3 treated adults were adherent, i.e. more than 80% of days covered by a treatment. This proportion reached 37.4% in the high-risk group, with no significant difference of adherence in people with or without a personal history of cardiovascular disease in this group.This study showed that hypercholesterolemia is a common metabolic disease in France, affecting 23.3% of the population. Lipid-lowering prescriptions diverged greatly from current recommendations, with less than a third of eligible patients being treated.
Collapse
Affiliation(s)
- Jacques Blacher
- Diagnosis and Therapeutic Center, Hotel Dieu; AP-HP; University Paris Descartes, Paris
| | | | - Alexandre Vallée
- Diagnosis and Therapeutic Center, Hotel Dieu; AP-HP; University Paris Descartes, Paris
| | - Jean Ferrières
- Cardiology Department; INSERM UMR 1027; Toulouse University Hospital; 30159 Toulouse
| | - Eric Bruckert
- Endocrinology, metabolism and cardiovascular prevention; E3 M Institut and cardiometabolic IHU (ICAN) Pitié Salpêtrière hospital, Paris
| | - Michel Farnier
- Point Médical and Cardiology Department, CHU Dijon-Bourgogne, Dijon, France
| | | |
Collapse
|
6
|
Barroso M, Zomeño MD, Díaz JL, Pérez-Fernández S, Martí-Lluch R, Cordón F, Ramos R, Cabezas C, Salvador G, Castell C, Schröder H, Grau M. Control of cardiovascular risk factors with tailored recommendations: A randomized controlled trial. Prev Med 2020; 141:106302. [PMID: 33144141 DOI: 10.1016/j.ypmed.2020.106302] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 10/13/2020] [Accepted: 10/22/2020] [Indexed: 12/11/2022]
Abstract
This study analyzed the efficacy of tailored recommendations to control cardiovascular risk factors at 1-year follow-up in a population-based randomized controlled trial in individuals aged 35-74 years with no history of cardiovascular disease at baseline. Total, low-density lipoprotein (LDL), and high-density lipoprotein cholesterol and systolic and diastolic blood pressure (BP) were measured at baseline and at 1-year follow-up. The primary outcome was the quantitative change in total cholesterol. To estimate the differences within and between groups, McNemar and Student t-tests were applied according to an intention-to-treat strategy. We enrolled 955 individuals [52.3% women; mean age, 50 years (standard deviation 10)]. Finally, 1 participant in each group presented a cardiovascular event and 768 were reexamined at 1-year follow-up. Intervention and control groups showed significant increases in total cholesterol [5.49 (standard deviation 1.02) to 5.56 (1.06) mmol/L and 5.34 (0.94) to 5.43 (0.93) mmol/L, respectively]. Men in the intervention group showed significant decreases in systolic and diastolic BP [117.2 (14.6) to 115.6 mmHg (14.1) and 77.9 (9.7) to 76.5 mmHg (9.7), respectively]; no changes were found in the rates of total cholesterol <5.2 mmol/L and LDL cholesterol <3.0 mmol/L. In the control group, both values were significantly decreased (43.5 to 36.4% and 26.4 to 20.8%, respectively) in men. In the stratified analysis, women showed no differences in any of the outcomes. In conclusion, an intervention with tailored recommendations increased mean total cholesterol values. The intervention effect was higher in men who maintained blood lipids at optimal levels and had decreased BP values.
Collapse
Affiliation(s)
- María Barroso
- Cardiovascular Epidemiology and Genetics Research Group, IMIM-Hospital del Mar Research Institute, Barcelona, Spain; Department of Pediatrics, Obstetrics, Gynecology and Preventive Medicine, School of Medicine, Autonomous University of Barcelona, Spain; Eastfield Health, Ashburton, New Zealand
| | - M Dolors Zomeño
- Cardiovascular Risk and Nutrition, IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain; School of Health Sciences, Blanquerna-Ramon Llull University, Barcelona, Spain
| | - Jorge L Díaz
- Cardiovascular Epidemiology and Genetics Research Group, IMIM-Hospital del Mar Research Institute, Barcelona, Spain; Docent Unit Preventive Medicine and Public Health Parc de Salut Mar, Barcelona Public Health Agency, Pompeu-Fabra University, Barcelona, Spain
| | - Silvia Pérez-Fernández
- Regicor Research Group, IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain; Consortium for Biomedical Research in Cardiovascular Disease (CIBERCV), Barcelona, Spain
| | | | - Ferran Cordón
- Primary Care Services, Catalan Institute of Health, Girona, Catalunya, Spain; Department of Medical Sciences, School of Medicine, University of Girona, Spain
| | - Rafel Ramos
- ISV Girona, IDIAP Jordi Gol, Girona, Catalunya, Spain; Department of Medical Sciences, School of Medicine, University of Girona, Spain; Girona Biomedical Research Institute, Girona, Spain
| | | | | | | | - Helmut Schröder
- Cardiovascular Risk and Nutrition, IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain; Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Barcelona, Spain
| | - María Grau
- Cardiovascular Epidemiology and Genetics Research Group, IMIM-Hospital del Mar Research Institute, Barcelona, Spain; Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Barcelona, Spain; Serra Húnter Fellow, Department of Medicine, University of Barcelona, Barcelona, Spain.
| |
Collapse
|
7
|
Gender Differences in Patient Experience Across Medicare Advantage Plans. Womens Health Issues 2020; 30:477-483. [DOI: 10.1016/j.whi.2020.08.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 08/25/2020] [Accepted: 08/26/2020] [Indexed: 11/24/2022]
|
8
|
Sex differences in the risk of vascular disease associated with diabetes. Biol Sex Differ 2020; 11:1. [PMID: 31900228 PMCID: PMC6942348 DOI: 10.1186/s13293-019-0277-z] [Citation(s) in RCA: 86] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 12/05/2019] [Indexed: 02/08/2023] Open
Abstract
Diabetes is a strong risk factor for vascular disease. There is compelling evidence that the relative risk of vascular disease associated with diabetes is substantially higher in women than men. The mechanisms that explain the sex difference have not been identified. However, this excess risk could be due to certain underlying biological differences between women and men. In addition to other cardiometabolic pathways, sex differences in body anthropometry and patterns of storage of adipose tissue may be of particular importance in explaining the sex differences in the relative risk of diabetes-associated vascular diseases. Besides biological factors, differences in the uptake and provision of health care could also play a role in women’s greater excess risk of diabetic vascular complications. In this review, we will discuss the current knowledge regarding sex differences in both biological factors, with a specific focus on sex differences adipose tissue, and in health care provided for the prevention, management, and treatment of diabetes and its vascular complications. While progress has been made towards understanding the underlying mechanisms of women’s higher relative risk of diabetic vascular complications, many uncertainties remain. Future research to understanding these mechanisms could contribute to more awareness of the sex-specific risk factors and could eventually lead to more personalized diabetes care. This will ensure that women are not affected by diabetes to a greater extent and will help to diminish the burden in both women and men.
Collapse
|
9
|
Urban Green Space Is Spatially Associated with Cardiovascular Disease Occurrence in Women of Mashhad: a Spatial Analysis of Influential Factors on their Presence in Urban Green Spaces. J Urban Health 2019; 96:653-668. [PMID: 31385136 PMCID: PMC6814665 DOI: 10.1007/s11524-019-00373-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Chronic diseases have spread around the world. Cardiovascular diseases (CVD), the most important of the chronic diseases and the leading cause of death in women of Mashhad, are impacted by environmental factors. Urban green spaces (UGSs) are important environmental factors playing a critical role in the prevention and control of CVD. Spatial analysis is useful in understanding the application of UGSs in CVD prevention. To identify the spatial distribution of CVD in Mashhad, Moran's index was used and 7539 home addresses of female patients with CVD were imported into ArcMap. Moran's coefficient was estimated to be 0.34, revealing a clustered distribution of CVD. The spatial autocorrelation between CVD and UGSs was analyzed using Moran's I. Moran's I index value was calculated to be - 0.15, and four types of clusters were identified in eight sub-districts of Mashhad municipality. To find the factors influencing the presence in UGSs among women affected by CVD, 607 female patients living in the selected sub-districts were asked to take part in a telephone survey. Data were analyzed using ordinary least squares (OLS) and geographically weighted regression (GWR) at block level (343 statistical blocks in total). Accordingly, the spatial diversity and effects of three variables of income, level of education, and access to UGSs among female patients with CVD were measured. According to OLS results and the standard residual, two clusters were removed. Finally, vulnerable blocks were identified that could be helpful in the development of prevention policies and place-based interventions.
Collapse
|
10
|
Harrington KM, Nguyen XMT, Song RJ, Hannagan K, Quaden R, Gagnon DR, Cho K, Deen JE, Muralidhar S, O'Leary TJ, Gaziano JM, Whitbourne SB. Gender Differences in Demographic and Health Characteristics of the Million Veteran Program Cohort. Womens Health Issues 2019; 29 Suppl 1:S56-S66. [PMID: 31253243 PMCID: PMC7061933 DOI: 10.1016/j.whi.2019.04.012] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 04/13/2019] [Accepted: 04/19/2019] [Indexed: 01/16/2023]
Abstract
BACKGROUND The Department of Veterans Affairs Million Veteran Program (MVP) is the largest ongoing cohort program of its kind, with 654,903 enrollees as of June 2018. The objectives of this study were to examine gender differences in the MVP cohort with respect to response and enrollment rates; demographic, health, and health care characteristics; and prevalence of self-reported health conditions. METHODS The MVP Baseline Survey was completed by 415,694 veterans (8% women), providing self-report measures of demographic characteristics, health status, and medical history. RESULTS Relative to men, women demonstrated a higher positive responder rate (23.0% vs. 16.0%), slightly higher enrollment rate (13.5% vs. 12.9%), and, among enrollees, a lower survey completion rate (59.7% vs. 63.8%). Women were younger, more racially diverse, had higher educational attainment, and were less likely to be married or cohabitating with a partner than men. Women were more likely to report good to excellent health status but poorer physical fitness, and less likely to report lifetime smoking and drinking than men. Compared with men, women veterans showed an increased prevalence of musculoskeletal conditions, thyroid problems, gastrointestinal conditions, migraine headaches, and mental health disorders, as well as a decreased prevalence of gout, cardiovascular diseases, high cholesterol, diabetes, and hearing problems. CONCLUSIONS These results revealed some substantial gender differences in the research participation rates, demographic profile, health characteristics, and prevalence of health conditions for veterans in the MVP cohort. Findings highlight the need for tailoring recruitment efforts to ensure representation of the increasing women veteran population receiving care through the Veterans Health Administration.
Collapse
Affiliation(s)
- Kelly M Harrington
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, Massachusetts; Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts.
| | - Xuan-Mai T Nguyen
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, Massachusetts; Department of Medicine, Division of Aging, Brigham and Women's Hospital, Boston, Massachusetts; Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Rebecca J Song
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, Massachusetts; Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
| | - Keri Hannagan
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, Massachusetts
| | - Rachel Quaden
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, Massachusetts
| | - David R Gagnon
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, Massachusetts; Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
| | - Kelly Cho
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, Massachusetts; Department of Medicine, Division of Aging, Brigham and Women's Hospital, Boston, Massachusetts; Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Jennifer E Deen
- Office of Research and Development, Veterans Health Administration, Washington, District of Columbia
| | - Sumitra Muralidhar
- Office of Research and Development, Veterans Health Administration, Washington, District of Columbia
| | - Timothy J O'Leary
- Office of Research and Development, Veterans Health Administration, Washington, District of Columbia; Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland
| | - John Michael Gaziano
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, Massachusetts; Department of Medicine, Division of Aging, Brigham and Women's Hospital, Boston, Massachusetts; Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Stacey B Whitbourne
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, Massachusetts; Department of Medicine, Division of Aging, Brigham and Women's Hospital, Boston, Massachusetts; Department of Medicine, Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
11
|
How Do Gender Differences in Quality of Care Vary Across Medicare Advantage Plans? J Gen Intern Med 2018; 33:1752-1759. [PMID: 30097976 PMCID: PMC6153209 DOI: 10.1007/s11606-018-4605-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 05/29/2018] [Accepted: 07/13/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Healthcare Effectiveness Data and Information Set (HEDIS) quality measures have long been used to compare care across health plans and to study racial/ethnic and socioeconomic disparities among Medicare Advantage (MA) beneficiaries. However, possible gender differences in seniors' quality of care have received less attention. OBJECTIVE To test for the presence and nature of any gender differences in quality of care across MA Plans, overall and by domain; to identify those most at risk of poor care. DESIGN Cross-sectional analysis of individual-level HEDIS measure scores from 23.8 million records using binomial mixed-effect models to estimate the effect of gender on performance. For each measure, we assess variation in gender gaps and their correlation with plan performance. PARTICIPANTS Beneficiaries from 456 MA plans in 2011-2012 HEDIS data. MAIN MEASURES Performance on 32 of 34 HEDIS measures which were available in both measurement years. The two excluded measures had mean performance scores below 10%. KEY RESULTS Women experienced better quality of care than men for 22/32 measures, with most pertaining to screening or treatment. Men experienced better quality on nine measures, including four related to cardiovascular disease and three to potentially harmful drug-disease interactions. Plans varied substantially in the magnitude of gender gaps for 21/32 measures; in general, the gender gap in quality of care was least favorable to men in low-performing plans. CONCLUSIONS Women generally experienced better quality of care than men. However, women experienced poorer care for cardiovascular disease-related intermediate outcomes and potentially harmful drug-disease interactions. Quality improvement may be especially important for men in low-performing plans and for cardiovascular-related care and drug-disease interactions for women. Gender-stratified reporting could reveal gender gaps, identify plans for which care varies by gender, and motivate efforts to address faults and close the gaps in the delivery system.
Collapse
|