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. 2013 Jul;28 Suppl 2(Suppl 2):S529-35.
doi: 10.1007/s11606-013-2340-5.

Accounting for clinical action reduces estimates of gender disparities in lipid management for diabetic veterans

Varsha G Vimalananda  1 , Donald R Miller, Timothy P Hofer, Robert G Holleman, Mandi L Klamerus, Eve A Kerr
Affiliations

Accounting for clinical action reduces estimates of gender disparities in lipid management for diabetic veterans

Varsha G Vimalananda et al. J Gen Intern Med. 2013 Jul.

Abstract

Background: Women with diabetes have higher low-density lipoprotein (LDL) levels than men, resulting in apparent disparities between genders on quality indicators tied to LDL thresholds.

Objective: To investigate whether gender disparities persist when accounting for clinical action with statins or cardiovascular risk.

Design: Retrospective cohort study.

Participants: Veterans Health Administration patients (21,780 women and 646,429 men) aged 50-75 with diabetes.

Main measures: Threshold measure: LDL < 100 mg/dL; clinical action measure: LDL < 100 mg/dL; or LDL ≥ 100 mg/dL and the patient was prescribed a moderate or high-dose statin at the time of the test; or LDL ≥ 100 mg/dL and the patient received other appropriate clinical action within 90 days; adherence: continuous multiple interval measure of gaps in dispensed medication (CMG).

Key results: Women were much less likely to have LDL < 100 mg/dL than were men (55 % vs. 68 %). This disparity narrowed from 13 % to 6 % for passing the clinical action measure (79 % vs. 85 %). These gender differences persisted among those with ischemic heart disease (IHD). Women had a lower odds of passing the clinical action measure (odds ratio 0.68, 95 % confidence interval 0.66-0.71). Among those with IHD, the gender gap increased with age. Differences in pass rates were explained by women's higher LDL levels, but not by their slightly worse adherence (3 % higher CMG).

Conclusions: Women and men veterans receive more similar quality of care for lipids in diabetes than previously indicated. Less reassuringly, the remaining gender differences appear to be as common in women at high cardiovascular risk as in those at low risk. Rather than focus on simply improving LDL levels in all women with diabetes, future efforts should ensure that patients with high cardiovascular risk are appropriately treated with statins when clinically indicated, feasible, and concordant with patient preferences.

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Figures

Figure 1.
Figure 1.
Effects of age and ischemic heart disease on likelihood of passing clinical action measure for lipid management in diabetes, by gender.
See this image and copyright information in PMC

References

    1. Ferrara A, Mangione CM, Kim C, Marrero DG, Curb D, Stevens M, et al. Sex disparities in control and treatment of modifiable cardiovascular disease risk factors among patients with diabetes: Translating Research Into Action for Diabetes (TRIAD) study. Diabetes Care. 2008;31(1):69–74. doi: 10.2337/dc07-1244. - DOI - PubMed
    1. Gouni-Berthold I, Berthold HK, Mantzoros CS, Bohm M, Krone W. Sex disparities in the treatment and control of cardiovascular risk factors in type 2 diabetes. Diabetes Care. 2008;31(7):1389–91. doi: 10.2337/dc08-0194. - DOI - PMC - PubMed
    1. Kanaya AM, Grady D, Barrett-Connor E. Explaining the sex difference in coronary heart disease mortality among patients with type 2 diabetes mellitus: a meta-analysis. Arch Intern Med. 2002;162(15):1737–45. doi: 10.1001/archinte.162.15.1737. - DOI - PubMed
    1. Shalev V, Chodick G, Heymann AD, Kokia E. Gender differences in healthcare utilization and medical indicators among patients with diabetes. Public Health. 2005;119(1):45–9. doi: 10.1016/j.puhe.2004.03.004. - DOI - PubMed
    1. Tseng CL, Sambamoorthi U, Rajan M, Tiwari A, Frayne S, Findley P, et al. Are there gender differences in diabetes care among elderly Medicare enrolled veterans? J Gen Intern Med. 2006;21(Suppl 3):S47–53. doi: 10.1111/j.1525-1497.2006.00374.x. - DOI - PMC - PubMed

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