Race and sex differences in the management of coronary artery disease

Although numerous studies have documented race and sex differences in the t reatment of coronary artery disease, the available analyses have not been c omprehensively evaluated. In this review, we summarize prior estimates of r ace and sex disparities in the utilization of standard tests and therapies, and we evaluate studies of factors that may contribute to gaps in care. Th e studies presented consistently demonstrate that blacks and women with cor onary artery disease, compared with whites and men, are substantially less likely to receive standard interventions. Studies also indicate that racial differences relate in part to socioeconomic Factors, process-of-care varia bles, and patient preferences, whereas sex differences relate in part to cl inical factors. In both cases, however, our understanding is limited by def iciencies in currently available datasets. Moreover, factors that have been shown to contribute to race and sex disparities in medical care fail to ex plain them fully. In both cases, physician decisionmaking appears to contri bute as well, suggesting that subconscious biases may contribute to treatme nt disparities. We conclude by proposing initiatives to remedy race and sex disparities in medical care. Efforts should focus on increasing physician aware ness of this problem. Studies should gather data that are currently u navailable for analysis, including detailed clinical variables and patient- level socioeconomic information. Finally, novel quality assurance programs, designed to evaluate and improve the care of blacks and women with coronar y artery disease, should be promptly undertaken.