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Researchers examine gender disparities in the quality of preventive care and management of heart disease and diabetes

Studies continue to document persistent disparities in health care associated with women's race, ethnicity, income, education, and other factors. Differences also remain between men and women in the receipt of quality health care. A special March 2006 issue of Women's Health Issues, 16(2), addresses disparities in the quality of preventive and chronic care. The five papers and a commentary prepared for the issue are based on analyses of data sources used by the Agency for Healthcare Research and Quality's (AHRQ's) National Healthcare Quality Report (NHQR) and the National Healthcare Disparities Report (NHDR).

The introduction to the theme issue is written by guest editor, Rosaly Correa-de-Araujo, M.D., M.Sc., Ph.D., AHRQ's Director of Women's Health and Gender-Based Research. The commentary is prepared by Dr. Correa-de-Araujo and AHRQ Director, Carolyn M. Clancy, M.D. Following are brief summaries of the introduction, commentary, and five papers in the issue.

Correa-de-Araujo, R. "Introduction: Women, gender, and health care disparities," p. 40.

Dr. Correa-de-Araujo notes that the five journal articles are based on analysis of a variety of well-established reliable national databases such as AHRQ's Medical Expenditure Panel Survey and Healthcare Cost and Utilization Project. The authors of the articles went beyond the condensed analyses presented by the NHQR and NHDR to focus on issues pertinent to women's health care and policy. One major goal of this journal issue is to stimulate further research, targeting the reasons behind gender, racial, and ethnic disparities in care as well as the development of quality improvement strategies to help eliminate disparities.

Correa-de-Araujo, R., and Clancy, C.M. "Commentary: Catalyzing quality of care improvements for women," pp. 41-43.

Despite the amount of data available, in-depth analysis of gender differences in the quality of health services provided in the United States is still limited, say the authors. The studies included in this issue are an important step in that direction. Their findings, combined with the evidence-based information that supports decisionmaking, may serve to catalyze the development of models of care delivery that are patient-centered and customized to individuals' needs and preferences.

The studies reveal, for example, that older and rural women receive less preventive care than other women, and that women receive less drug therapy for heart disease than men. They also show that minority women, especially Hispanic women, use fewer health care services than white women. A substantial proportion of women are not satisfied with the quality of the care they receive. For women with diabetes, hospitalizations decrease as income and educational levels increase. Finally, the authors note that health care professionals need access to evidence-based information and effective models of care delivery in order to provide the best care to women worldwide.

Correa-de-Araujo, R., Stevens, B., Moy, E., and others. "Gender differences across racial and ethnic groups in the quality of care for acute myocardial infarction and heart failure associated with comorbidities," pp. 44-55.

This paper provides important insights on gender differences across racial and ethnic groups in a Medicare population in the quality of care received for acute myocardial infarction (AMI, heart attack) or congestive heart failure (CHF). It shows that women with AMI or CHF continue to fare worse than men in the receipt of drug therapy. Also, rates of counseling to quit smoking (a risk factor for heart disease) are low among women and men of any race and ethnicity, but worse among Hispanic and black men. Further, women or men who have other medical conditions associated with AMI or CHF (such as diabetes, hypertension, or end-stage renal disease), do not receive better quality cardiovascular care than those with the heart conditions alone.

Correa-de-Araujo, R., McDermott, K., and Moy, E. "Gender differences across racial and ethnic groups in the quality of care for diabetes," pp. 56-65.

According to this analysis of 10 quality of care measures defined by the NHQR and NHDR, only 29 percent of women and 34 percent of men with diabetes receive the 5 recommended care processes for diabetes care: regular blood sugar measurements, regular eye and foot exams, influenza vaccination within the past year, and lipid profile within the past 2 years. Men and women have similar hospitalization rates for uncontrolled diabetes, yet complications with lower extremity amputations (the result of uncontrolled diabetes) remain higher for black and Hispanic men. Also, avoidable hospitalizations for diabetes decrease as income and education increase among women across racial and ethnic groups.

Taylor, A.K., Larson, S., and Correa-de-Araujo, R. "Women's health care utilization and expenditures," pp. 66-79.

This comprehensive review of U.S. women's health care use and expenditures shows that in 2000, 91 percent of adult women used some form of health care services. Overall, 82 percent of adult women reported an ambulatory care visit and 11 percent were hospitalized. Mean expense per woman was $3,219 for that year. The most notable findings indicate that women with private insurance and those on Medicaid were more likely to use health services than uninsured women. White women continued to use any type of health service more often and used more prescription drugs than minority women and men. However, both white and Hispanic women paid a higher proportion of income for out-of-pocket medical care expenses. Finally, nearly 30 percent of older women in fair or poor health spent 10 percent or more of their income for out-of-pocket medical care.

Larson, S. and Correa-de-Araujo, R. "Preventive health examinations: A comparison along the rural-urban continuum," pp. 80-88.

According to this study, women from rural areas receive less preventive care than those residing in urban areas. The researchers analyzed 2000 data from the Medical Expenditure Panel Survey to examine differences in reports of preventive health service use in four types of counties: large metropolitan counties, small metropolitan counties, counties adjacent to metropolitan areas, and rural counties not adjacent to metropolitan areas or with fewer than 10,000 residents. Rural women were less likely to obtain blood cholesterol tests, dental exams, and mammograms during the previous 2 years when compared with urban women, but were more likely to obtain blood pressure checks during the previous year. Rural residents on average, had lower incomes and less education, and were more likely to be uninsured and face structural barriers to care, such as long travel times, than their urban counterparts.

Kosiak, B., Sangl, J., and Correa-de-Araujo, R. "Quality of health care for older women: What do we know?", pp. 89-99.

Women comprise nearly 60 percent of those on Medicare and depend on the program for an average of 15 years compared with 7 years for men. This article establishes a rough baseline for the quality of care, primarily preventive care, received by older women compared with older men, using selected measures and data from the 2004 NHQR and NHDR. Generally, older white women tend to receive better quality of care than their Hispanic and black counterparts, and more educated women often receive better quality of care than their less-educated peers. Also, older women are significantly less likely than older men to receive a number of preventive tests, have their blood pressure under control, or receive aspirin or beta-blockers upon hospital admission or discharge for heart attack. Results are mixed for certain care measures related to diabetes, but improved rates of eye and foot exams are clearly needed for older women. Rates of influenza and pneumococcal vaccinations are low, but can be improved through Medicare-covered services.

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