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Gender Disparities in the Pharmacological Treatment of Cardiovascular Disease and Diabetes Mellitus in the Very Old

An Epidemiological, Cross-Sectional Survey

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Abstract

Background: There are many reports of disparities in health and medical care both between women and men and between various age groups. In most cases, men receive better treatment than women and young and middle-aged people are privileged compared with the old and the very old. Cardiovascular morbidity and diabetes mellitus are common, increase with age and are often treated extensively with drugs, many of which are known to have significant adverse effects.

Objective: The aim of the study was to analyse gender differences in the pharmacological treatment of cardiovascular disease and diabetes among very old people.

Methods: The study took the form of an epidemiological, cross-sectional survey. A structured interview was administered during one or more home visits, and data were further retrieved from medical charts and interviews with relatives, healthcare staff and other carers. Home-dwelling people as well as people living in institutional care in six municipalities in the county of Västerbotten, Sweden, in 2005–7 were included in the study. Half of all people aged 85 years, all of those aged 90 years and all of those aged ≥95 years living in the selected municipalities were selected for inclusion in the study. In total, 467 people were included in the present analysis. The main study outcome measures were medical diagnoses and drug use.

Results: In total, women were prescribed a larger number of drugs than men (mean 7.2 vs 5.4, p<0.001). Multiple logistic regression models adjusted for age and other background variables as well as relevant medical diagnoses (hypertension, heart failure) showed strong associations between female sex and prescriptions of thiazide diuretics (odds ratio [OR] 4.4; 95% CI 1.8, 10.8; p = 0.001), potassium-sparing diuretics (OR 3.5; 95% CI 1.4, 8.7; p = 0.006) and diuretics as a whole (OR 1.8; 95% CI 1.1, 2.9; p = 0.021). A similar model, adjusted for angina pectoris, showed that female sex was associated with prescription of short-acting nitroglycerin (OR 3.7; 95% CI 1.6, 8.9; p = 0.003). However, more men had been offered coronary artery surgery (p = 0.001). Of the participants diagnosed with diabetes, 55% of the women and 85% of the men used oral antihyperglycaemic drugs (p = 0.020), whereas no gender difference was seen in prescriptions of insulin.

Conclusions: Significant gender disparities in the prescription of several drugs, such as diuretics, nitroglycerin and oral antihyperglycaemic drugs, were observed in this study of very old people. In most cases, women were prescribed more drugs than men. Men more often had undergone coronary artery surgery. These disparities could only in part be explained by differences in diagnoses and symptoms.

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Acknowledgements

This study was supported by grants from the European Union Bothnia-Atlantica Program, the Vårdal Research Foundation, the King Gustav V’s and Queen Viktoria’s Foundation of Freemasons, the Umeå University Foundations for Medical Research, the Erik and Anne-Marie Detlof’s Foundation at Umeå University, the Swedish Dementia Association and Interreg IIIA Mitt-Skandia.

None of the funding sources had any financial interest in the study, and none of them were involved in the data collection or the analyses. The authors declare that they have no competing interests.

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Authors and Affiliations

  1. Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, Umeå, SE-90187, Sweden

    Jon Brännström BSc, Lena Molander, Hugo Lövheim & Yngve Gustafson

  2. Department of Public Health and Clinical Medicine, Family Medicine, Umeå University, Umeå, Sweden

    Katarina Hamberg

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  1. Jon Brännström BSc
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Correspondence to Jon Brännström BSc.

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Brännström, J., Hamberg, K., Molander, L. et al. Gender Disparities in the Pharmacological Treatment of Cardiovascular Disease and Diabetes Mellitus in the Very Old. Drugs Aging 28, 993–1005 (2011). https://doi.org/10.2165/11594730-000000000-00000

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