Sex differences in cardiovascular disease: are women with low socioeconomic status at high risk?

Background. Cardiovascular disease is still portrayed as a typical male dis ease, and men are more often submitted to invasive procedures or referred e arlier. Aim. To explore sex differences in morbidity and referral patterns in cardi ovascular disease in general practice, and the role of age and socioeconomi c status. Method. Data were obtained from a continuous morbidity registration project in the Netherlands from 1986 to 1995 in which 12 000 patients were followe d over 10 years. The effects of sex, age, and socioeconomic status on morbi dity of cardiovascular disease and the referral patterns were established. Results. The sex difference in morbidity becomes smaller with increasing ag e. Morbidity was highest in the lower socioeconomic status in general and f or angina pectoris in particular. Women with angina pectoris with low socio economic status have a relative risk of 2.24 (CI = 1.17-3.26) compared with women with high socioeconomic status. In men, no significant difference wa s found between the socioeconomic status groups. For angina pectoris the se x difference in referral to the specialist was most significant 50.6% and 2 6.6% (P = 0.002) for men and women respectively. Conclusion. For women, low socioeconomic status was associated with relativ ely higher morbidity of angina pectoris and myocardial infarction than for men. Women are less likely to be referred than men are, in particular for a ngina pectoris.