Gender disparities in the quality of cardiovascular disease care in private managed care plans

Background. Studies have shown that women with cardiovascular disease (CVD) are screened and treated less aggressively than men and are less likely to undergo cardiac procedures. Research in this area has primarily focused on the acute setting, and there are limited data on the ambulatory care setting, particularly among the commercially insured. To that end, the objective of this study is to determine if gender disparities in the quality of CVD care exist in commercial managed care populations. Methods. Using a national sample of commercial health plans, we analyzed member-level data for 7 CVD quality indicators from the Healthcare Effectiveness Data and Information Set (HEDIS (R)) collected in 2005. We used hierarchical generalized linear models to estimate these HEDIS measures as a function of gender, controlling for race/ethnicity, socioeconomic status, age, and plans' clustering effects. Results. Results showed that women were less likely than men to have low-density lipoprotein (LDL) cholesterol controlled at < 100 mg/dL in those who have diabetes (odds ratio [OR], 0.81; 95% confidence interval [CI], 0.76-0.86) or a history of CVD (OR, 0.72; CI 95%, 0.64-0.82). The difference between men and women in meeting the LDL control measures was 5.74% among those with diabetes (44.3% vs. 38.5%) and 8.53% among those with a history of CVD (55.1% vs. 46.6%). However, women achieved higher performance than men in controlling blood pressure (OR, 1.12; 95% Cl, 1.02-1.21), where the rate of women meeting this quality indicator exceeded that of men by 1.94% (70.8% for women vs. 68.9% for men). Conclusions. Gender disparities in the management and outcomes of CVD exist among patients in commercial managed care plans despite similar access to care. Poor performance in LDL control was seen in both men and women, with a lower rate of control in women suggesting the possibility of less intensive cholesterol treatment in women. The differences in patterns of care demonstrate the need for interventions tailored to address gender disparities.