Patient Safety and Quality

Women in Medicare and private managed care plans receive worse care than men for cardiovascular disease and diabetes

Women in Medicare and private managed care plans receive worse care than men for cardiovascular disease and diabetes, concludes a new study. For example, both women with diabetes and women who had suffered a heart attack were far less likely than their male counterparts to have their low density lipoprotein cholesterol (LDL-C) controlled, a risk factor for more diabetic and cardiac problems. These disparities existed despite women's more frequent visits to the doctor, which should have provided more opportunities to receive indicated care, note the study authors.

They analyzed data from 10 commercial and 9 Medicare managed care plans and calculated performance on 7 measures of quality of care. These included: beta blocker use after heart attack and LDL-C check after a cardiac event; in patients with diabetes, checking for elevated blood-sugar levels (glycosylated hemoglobin, HbA1c), LDL-C, abnormal kidney functioning (a diabetes-related complication), and eye checks for diabetic retinopathy; as well as use of angiotensin-converting enzyme (ACE) inhibitors for congestive heart failure.

Some plans also provided information on four other measures: control of LDL-C after a cardiac event, blood pressure control in hypertensive patients, and HbA1c and LDL-C control in diabetics. There were significant gender differences on 5 of the 11 measures among Medicare enrollees, with 4 favoring men, after adjusting for age, race/ethnicity, socioeconomic status, and health plan. There were gender differences among commercial enrollees for 8 of 11 measures, with 6 favoring men.

The largest gender disparity was in control of LDL-C among patients with diabetes. Medicare-insured women were 19 percent less likely and women in private HMOs were 16 percent less likely than men to achieve LDL-C control. These results underscore the need to improve the quality of care for cardiovascular and diabetes care for women.

The study was supported by the Agency for Healthcare Research and Quality (Contract No. 290-00-0012).

See "Does quality of care for cardiovascular disease and diabetes differ by gender for enrollees in managed care plans?" by Chloe E. Bird, Ph.D., Allen M. Fremont, M.D., Ph.D., Arlene S. Bierman, M.D., M.S., and others, in the May/June 2007 Women's Health Issues 17, pp. 131-138.

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