Gender differences in descriptions of angina symptoms and health problems immediately prior to angiography: the ACRE study

Although the prevalence of angina in women is increasing, women are less li kely than men to undergo invasive management of coronary disease. Gender di fferences in language use may contribute to disparities in management, sinc e the diagnosis: of angina relies on a patient's description of their sympt oms. This: study set out to investigate whether gender differences exist in the language used vc when describing angina symptoms and perceived health problems at the time of angiography, which might influence the rate of subs equent revascularisation. Content analysis was used to analyse written acco unts of 'symptoms and health problems' in 200 (96 female) patients randomly selected within age strata who were undergoing coronary angiography for ch ronic stable angina in the Appropriateness of Coronary Revascularisation (A CRE) study. Written free text was coded into seven categories: pain locatio n (chest or arm and throat, neck or jaw); pain character; breathlessness; o ther symptoms: effects on lifestyle; symptom attributions; and patient disc ourses ('story' or 'factual'). Women described mure throat, neck or jaw pai n than men among those with low physical functioning (p = 0.06), in the pre sence of coronary artery disease (p = 0.03) and in those who were not subse quently revascularised (p = 0.05). Women also gave more accounts than men o f breathlessness and other symptoms, but there was little evidence for gend er differences in the use of 'factual' discourses. We conclude that from th e time of angiography. gender differences in language use do exist and desc ription of angina pain may influence subsequent revascularisation. Further research is necessary to investigate the nature and consequences of gender differences in language use at this and earlier stages in the referral proc ess. (C) 2001 Elsevier Science Ltd. All rights reserved.