William A. Ghali, MD, MPH; Peter D. Faris, PhD; P. Diane Galbraith, BN; Colleen M. Norris, MSc; Michael J. Curtis, MD; L. Duncan Saunders, PhD; Vladimir Dzavik, MD; L. Brent Mitchell, MD; Merril L. Knudtson, MD; Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease (APPROACH) Investigators*
Acknowledgment: The authors thank the Calgary Regional Health Authority and the Capital Health Authority for assistance with on-line data entry by cardiac catheterization laboratory personnel.
Grant Support: The APPROACH initiative was initially funded in 1995 by a grant from the Weston Foundation. The ongoing operation of the project has been made possible by contributions from the Province-Wide Services Committee of Alberta Health and Wellness, Merck Frosst Canada, Inc.; Monsanto Canada, Inc.–Searle; Eli Lilly Canada, Inc.; Guidant Corp.; Boston Scientific, Ltd.; Hoffmann–La Roche, Ltd.; and Johnson & Johnson, Inc.–Cordis. Analysis was supported by an operating grant from the Heart and Stroke Foundation of Canada. Dr. Ghali is supported by a Population Health Investigator Award from the Alberta Heritage Foundation for Medical Research, Edmonton, Alberta, and by a Government of Canada Research Chair in Health Services Research.
Requests for Single Reprints: William A. Ghali, MD, MPH, Faculty of Medicine, University of Calgary, 3330 Hospital Drive Northwest, Calgary, Alberta T2N 4N1, Canada; e-mail, email@example.com.
Potential Financial Conflicts of Interest: None disclosed.
Current Author Addresses: Dr. Ghali: University of Calgary, 3330 Hospital Drive Northwest, Calgary, Alberta T2N 4N1, Canada.
Dr. Faris and Ms. Galbraith: c/o Centre for Health and Policy Studies, 3330 Hospital Drive Northwest, Calgary, Alberta T2N 4N1, Canada.
Ms. Norris: APPROACH Project Office, 8111 1st Floor ABC, 8440—112 Street, Edmonton, Alberta T6G 2B7, Canada.
Drs. Curtis, Mitchell, and Knudtson: Foothills Hospital, 1403—29th Street Northwest, Calgary, Alberta T2N 2T9, Canada.
Dr. Saunders: University of Alberta, Room 13-106, 8440—112th Street, Edmonton, Alberta T6G 2B7, Canada.
Dr. Dzavik: 200 Elizabeth Street, EN 12-244a, Toronto, Ontario M5G 2C4, Canada.
Author Contributions: Conception and design: WA Ghali, LD Saunders, LB Mitchell, ML Knudtson.
Analysis and interpretation of the data: WA Ghali, PD Faris, PD Galbraith, CM Norris, MJ Curtis, ML Knudtson.
Drafting of the article: WA Ghali.
Critical revision of the article for important intellectual content: PD Faris, PD Galbraith, CM Norris, MJ Curtis, LD Saunders, V Dzavik, ML Knudtson.
Final approval of the article: WA Ghali, PD Galbraith, MJ Curtis, LD Saunders, V Dzavik, LB Mitchell, ML Knudtson.
Provision of study materials or patients: WA Ghali, V Dzavik, ML Knudtson.
Statistical expertise: WA Ghali, PD Faris, CM Norris.
Obtaining of funding: WA Ghali, LD Saunders, ML Knudtson.
Administrative, technical, or logistic support: WA Ghali, PD Galbraith, V Dzavik.
Collection and assembly of data: WA Ghali, PD Galbraith, V Dzavik.
Ghali W., Faris P., Galbraith P., Norris C., Curtis M., Saunders L., Dzavik V., Mitchell L., Knudtson M., ; Sex Differences in Access to Coronary Revascularization after Cardiac Catheterization: Importance of Detailed Clinical Data. Ann Intern Med. 2002;136:723-732. doi: 10.7326/0003-4819-136-10-200205210-00007
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Published: Ann Intern Med. 2002;136(10):723-732.
Reports of sex differences in the likelihood of undergoing cardiac procedures have led to suggestions of gender bias in cardiac care decision making (1-14). Other proposed explanations for the variation in use of cardiac procedures between sexes include differing patient preferences or differing clinical characteristics (for example, smaller coronary vessels in women).
Earlier studies did not unanimously find sex differences in cardiac procedure rates; some studies reported equivalent procedure rates for men and women (15-21). The inconsistency across studies may be related to differences in geographic regions and health systems. However, another possible explanation is that many earlier studies evaluated highly selected patient samples that may not reflect processes of care at a population level. Yet another possible explanation is that the published studies on this issue have used various data sources, ranging from highly detailed data from clinical trials to sparsely detailed administrative data.
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