Gender Bias in Stroke Care
I can't think of any adequate excuse for women to receive
medical care that is less good than that which is received by
men. However, evidence for this continues to surface. The latest
study to demonstrate this unsettling fact was published in the
September 27, 2005, issue of Neurology, the official journal of
the American Academy of Neurology. Melinda Smith and
co-investigators looked at stroke care between 2000 and 2002 in
the seven acute-care hospitals of Corpus Christi, Texas, which
includes all of the hospitals of Nueces County.
Patients hospitalized for stroke, a condition in which
interrupted circulation causes damage to the brain, should
receive a core battery of testing. Every stroke patient should
receive an echocardiogram, a soundwave-based test that shows
images of the heart and its various components in motion. This
is useful in showing if the heart might have generated the
stroke by sending clots or other material into the circulation
feeding the brain, and also to identify complications affecting
the heart itself. Moreover, patients believed to have a stroke
to the front part of the brain (which applies to most cases)
should receive testing for narrowing or blockage of the carotid
arteries. The carotids are the two pulsating blood-vessels in
the front of the neck which convey blood to the front of the
brain.
The researchers found that while 57% of the men with strokes
received an echocardiogram, this test was given to just 48% of
the women with strokes. And while 71% of the men received
carotid imaging, this test was provided to just 62% of the
women. Statistics showed that these differences were too large
to account for by chance alone. Moreover, the researchers
diligently searched for legitimate medical reasons to account
for the unequal testing--like differences in stroke risk-factors
or differences in recognition that a stroke had occurred--but
found that these could not account for the differences, either.
In truth, the extent of testing in even the men fell below
standards of care--and probably does so in other communities as
well--but for the current discussion, the emphasis is on the
differences in care provided to the two genders.
So, if these results can be generalized to practices elsewhere,
the sad truth is that if you are a woman with a stroke, your
care will not be as good as if you are a man. And,
unfortunately, the gender bias in stroke care demonstrated by
these researchers was not an isolated example. The authors
reviewed the results of other studies that showed:
* Sixty-two percent of stroke deaths in the United States occur
in women.
* Women have a lower incidence of stroke but worse outcomes than
men.
* One hospital's study showed that in their emergency department
women with strokes were evaluated less quickly than men with
strokes were.
* A multinational, hospital-based study showed fewer
brain-imaging, heart-imaging and blood-vessel-imaging studies in
women than in men.
* Women with strokes were less likely to receive blood-thinners
than men were.
* And, women were less likely to receive surgery to the carotid
arteries than men were.
What is more, gender differences in medical treatment of
coronary artery disease have also been demonstrated in Corpus
Christi and elsewhere. So, as indicated by the authors, gender
differences in medical care probably extend beyond the
evaluation and treatment of strokes.
One conclusion is unavoidable: The medical community still has a
long way to go in providing equal care to all the patients
entrusted to its care.
(C) 2005 by Gary Cordingley