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Sex Bias in Considering Coronary Bypass Surgery

JONATHAN N. TOBIN, M.A., M.Phil.; SYLVIA WASSERTHEIL-SMOLLER, Ph.D.; JOHN P. WEXLER, M.D., Ph.D.; RICHARD M. STEINGART, M.D.; NANCY BUDNER, M.P.H.; LLOYD LENSE, M.D.; and JOSEPH WACHSPRESS, M.D.
[+] Article and Author Information

Grant support: by grants HS-04854 and HS-05430 from the National Center for Health Services Research, OASH.

An earlier version of these findings was presented on 31 May 1986 at the Second Annual Meeting of the International Society for Technology Assessment in Health Care, National Academy of Sciences, Washington, D.C.

▸Requests for reprints should be addressed to Sylvia Wassertheil-Smoller, Ph.D.; Department of Epidemiology and Social Medicine, Albert Einstein College of Medicine, 1300 Morris Park Avenue; Bronx, NY 10461.


Bronx, New York


©1987 American College of PhysiciansAmerican College of Physicians


Ann Intern Med. 1987;107(1):19-25. doi:10.7326/0003-4819-107-1-19
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Cardiovascular nuclear medicine exercise studies may serve as a screening method to be used in making decisions to refer patients for catheterization and coronary artery bypass surgery. In a study of 390 patients consecutively referred for nuclear exercise testing, abnormal results found in 31% of the women and in 64% of the men affected physicians' decisions to recommend catheterization in men only; 4% of the women with abnormal radionuclide scans were referred for catheterization compared with 40% of the men (p < 0.001). This 10:1 ratio was independent of age. A multiple logistic regression analysis that controlled for age, previous myocardial infarction, presence of typical and atypical angina, and abnormal test results yielded an odds ratio of 6.3 for men. The male-to-female ratio of patients with coronary artery disease given abnormal results of a cardiovascular nuclear scan is only 2:1. Thus, the sex differential in decisions to refer patients for cardiac catheterization cannot be explained entirely by differences in the sensitivity of tests or the rates of coronary artery disease; it also cannot be explained by differential benefits from surgery. These findings raise the question of whether coronary artery bypass surgery is underused in women.

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