Relation of gender and health insurance to cardiovascular procedure use inpersons with progression of chronic renal disease

BACKGROUND. Women often are less likely than men to receive diagnostic and therapeutic invasive procedures for coronary disease. OBJECTIVE. TO examine the relation between gender, health insurance, and ac cess to cardiovascular procedures over time in persons with chronic illness . RESEARCH DESIGN. Seven-year longitudinal analyses in a cohort from the Unit ed States Renal Data System. SUBJECTS, National random sample of women and men who progressed to end-sta ge renal disease (ESRD) in 1986 to 1987 and were treated at 303 dialysis fa cilities (n = 4,987), MEASURES. Medical history and utilization records, physical examination, an d laboratory data MAIN OUTCOME MEASURES. Receipt of: a coronary catheterization or revascular ization procedure before (baseline) and after (follow-up) the development o f ESRD and acquisition of Medicare, adjusted for clinical and socioeconomic variables. RESULTS. At baseline, 5.2% of women and 9,2% of men had undergone a cardiac procedure; the odds of women receiving a procedure were one third lower th an for men (adjusted odds ratio 0.66 [95% CI 0.49-0,88]), During follow-up, women were? just as likely as men to undergo a procedure (adjusted odds ra tio 0,94 [95% CI 0,74-1.20]), Compared with men with baseline private insur ance, men and women with other and no insurance had 34% to 81% lower adds o f receiving procedures at baseline. Women with private insurance had 42% lo wer odds of having a procedure at baseline cam pared with men (adjusted odd s ratio 0.58 [95% CI 0,42-0,78]) but had the. same odds at follow-up (adjus ted odds ratio I,1.09 [95% CI 0,82-1.45]), At follow-up, gender differences in procedure use were eliminated for groups with baseline Medicaid or no i nsurance, CONCLUSIONS. Overall gender differences in cardiac procedure use were narro wed markedly after progression of a serious illness, the assurance of healt h insurance, and entry into a comprehensive care system, Gender disparities in procedure use for different baseline insurance groups were largely equa lized infollow-up. These findings suggest that provision of insurance with disease-managed care for a chronic disease-can provide equalized access to care for women.