Gender differences in accessing cardiac surgery across England: A cross-sectional analysis of the health survey for England

Objective: to examine gender differences in access to cardiac surgery in a nationally representative sample. Design: nationwide cross sectional househ old based survey (Health Survey for England). Setting: private households i n England around 1993 and 1993. Subjects. 1708 subjects reporting a his tor y of either doctor diagnosed angina or heart attack from a stratified rando m sample of 32 378 people aged 16 and above. Outcome measure: the proportio n reporting having had cardiac surgery or on a waiting list. Results: 13.5% reported previous (n = 206) or pending (n = 25) cardiac surgery. Men were more likely than women to have had or to be waiting for cardiac surgery (19 .1% of men versus 6.8% of women, chi(2) 54.7, P < 0.001). This finding was consistent regardless of age group and across three regional areas. The una djusted odds ratio for cardiac surgery for men versus women was 3.3 (95% CI 2.3, 4.5, P < 0.001) and was only slightly attenuated to 2.8 (95% CI 1.9, 4.0, P < 0.001), after adjust ment for other factors. The gender difference remained even when analysis was restricted to subjects reporting a previou s heart attack, and after statistical adjustment for disease severity. Conc lusion: women are less likely than men to receive cardiac surgery across al l age groups and regional areas. These results include private operations a nd adjust For individual behavioural data. Neither disease severity or co-m orbidity explains these discrepancies. Further studies are required to dete rmine why this inequality occurs and how it can be addressed. (C) 1998 Else vier Science Ltd. All rights reserved.