Gender differences in aspirin use among adults with coronary heart disease in the united states

Aspirin reduces mortality for men and women with coronary heart disease (CHD). Previous research suggests women with acute coronary syndromes receive less aggressive care, including less frequent early administration of aspirin. The presence of gender differences in aspirin use for secondary prevent...

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Published in:	Journal of general internal medicine : JGIM 2007, Vol.22 (1), p.55-61
Main Authors:	OPOTOWSKY, Alexander R, MCWILLIAMS, J. Michael, CANNON, Christopher P
Format:	Article
Language:	eng
Subjects:	Age Factors Aged Aspirin Aspirin - therapeutic use Biological and medical sciences Cardiology. Vascular system Cardiovascular disease Continental Population Groups Coronary Disease - drug therapy Coronary Disease - epidemiology Coronary heart disease Female Gender differences General aspects Health Behavior Health Care Surveys Heart Heart attacks Humans Insurance, Health Internal medicine Male Medical sciences Miscellaneous Myocardial Infarction - epidemiology Myocardial Infarction - prevention & control Original Platelet Aggregation Inhibitors - therapeutic use Preventive medicine Public health. Hygiene Public health. Hygiene-occupational medicine Sex Factors United States - epidemiology
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Summary:	Aspirin reduces mortality for men and women with coronary heart disease (CHD). Previous research suggests women with acute coronary syndromes receive less aggressive care, including less frequent early administration of aspirin. The presence of gender differences in aspirin use for secondary prevention is less clear. To determine if a gender difference exists in the use of aspirin for secondary prevention among individuals with CHD. We analyzed data from the nationally representative 2000-2002 Medical Expenditure Panel Surveys to determine the prevalence of regular aspirin use among men and women with CHD. Participants, 1,869, 40 years and older who reported CHD or prior myocardial infarction. Women were less likely than men to use aspirin regularly (62.4% vs 75.6%, p < .001) even after adjusting for demographic, socioeconomic and clinical characteristics (adjusted OR = 0.62, 95% CI, 0.48-0.79). This difference narrowed but remained significant when the analysis was limited to those without self-reported contraindications to aspirin (79.8% vs 86.4%, P = .002, adjusted OR = 0.68, 95% CI, 0.48-0.97). Women were more likely than men to report contraindications (20.5% vs 12.5%, P < .001). Differences in aspirin use were greater between women and men with private health insurance (61.8% vs 79.0%, P < .001, adjusted OR = 0.48, 95% CI, 0.35-0.67) than among those with public coverage (62.5% vs 70.7%, P = .04, adjusted OR = 0.74, 95% CI, 0.50-1.11) (P < .001 for gender-insurance interaction). We found a gender difference in aspirin use among patients with CHD not fully explained by differences in patient characteristics or reported contraindications. These findings suggest a need for improved secondary prevention of cardiovascular events for women with CHD.
ISSN:	0884-8734 1525-1497