J Epidemiol Community Health 63:203-208 doi:10.1136/jech.2008.077537
  • Research report

Sex differences in use of interventional cardiology persist after risk adjustment

Open Access
  1. N Nante1,
  2. G Messina1,
  3. M Cecchini1,
  4. O Bertetto2,
  5. F Moirano3,
  6. M McKee4
  1. 1
    Health Services Research Laboratory, University of Sienna, Sienna, Italy
  2. 2
    Regional Agency for Health Services of Piedmont, Piedmont Region, Turin, Italy
  3. 3
    Local Health Agency, Cuneo, Mondovì and Savigliano, Piedmont Region, Italy
  4. 4
    European Centre on Health of Societies in Transition, London School of Hygiene and Tropical Medicine, London, UK
  1. Professor N Nante, Health Services Research Laboratory, University of Sienna, Sienna, Italy; nante{at}
  • Accepted 26 October 2008
  • Published Online First 3 December 2008


Background: Studies from several countries have documented gender disparities in the management of coronary artery disease. Whether such gender disparities are seen in Italy and, if so, whether they can be explained by factors such as age and severity of illness were investigated.

Methods: 77 974 Piedmontese patients, admitted between 1999 and 2002, with a primary diagnosis of myocardial infarction (ICD 410), angina (ICD 413), chronic ischaemia (ICD 414) and chest pain (ICD 786.5) were studied. The number of men and women undergoing surgical treatment was extracted and the male–female odds ratios calculated. Several risk factors and a risk adjustment technique (APR-DRG) were used to control for possible confounders. Backward stepwise multiple logistic regression was used to adjust for significant covariates.

Results: Crude analysis demonstrated that gender is a discriminating factor in the probability of surgery (OR 2.11, 95% CI 2.04 to 2.19), with similar findings among those with each main diagnosis. The odds ratios decreased after adjustment for age, co-morbidity and disease severity but remained significant.

Conclusions: Men and women admitted to hospitals in a region of northern Italy with a diagnosis of cardiovascular disease are treated differently and this cannot be explained by age or severity of disease.


  • Competing interests: None.

  • The authors declare that they have the permission to use the dataset for the study from the Health Regional Agency of Piedmont Region.