AGE AND SEX-DIFFERENCES IN THE MANAGEMENT OF ISCHEMIC-HEART-DISEASE

Objective: To investigate age and sex differences in the utilisation o f hospital services for ischaemic heart disease. Design: Analysis of r outine mortality data and hospital activity data. Setting: South West Thames Regional Health Authority. Subjects: Residents of the South Wes t Thames Regional Health Authority who in 1991 either died from ischae mic heart disease or were admitted to an NHS hospital in England and W ales with a main diagnosis of ischaemic heart disease. Main outcome me asures: Ratio of consultant episodes to deaths from ischaemic heart di sease (as a proxy measure of the utilisation of hospital care), and th e percentages of consultant episodes in which further investigation (a ngiography or catheterisation) or revascularisation treatment (coronar y artery bypass grafting or angioplasty) were carried out. Results: Th e ratio of episodes to deaths was similar in men and women (odds ratio for men vs. women 0.96, 95% confidence intervals 0.90 to 1.03). The p ercentage of episodes in which further investigation was carried out w as higher in men than women (odds ratio for men vs. women 1.46, 95% co nfidence intervals 1.25 to 1.70) as was the percentage of episodes in which revascularisation treatment was carried out (odds ratio for men vs. women 1.46, 95% confidence intervals 1.20 to 1.77). The ratio of e pisodes to deaths, the percentage of episodes in which further investi gation was carried out, and the percentage of episodes in which revasc ularisation treatment was carried out all declined with age (all p val ues < 0.001). Conclusions: Women with ischaemic heart disease are as l ikely as men to be admitted to hospital, but after admission are less likely to undergo further investigation and revascularisation treatmen t. Elderly patients with ischaemic heart disease are less likely than younger patients to be admitted to hospital; after admission, they are also less likely to undergo further investigation and revascularisati on treatment. Further research is needed to determine whether these ag e and sex differences in the use of hospital services are clinically j ustified.