Women Receive Less Recommended Medications at Primary Care Provider than Men

Sanne Peters, PhD

New data from an analysis of more than 2.2 million patients indicates women may be less likely to receive certain recommend medications from their primary care doctor than their male counterparts.

Results of the systematic review and meta-analysis suggest women received 10% fewer statin prescriptions and 15% fewer angiotensin-converting enzyme (ACE) inhibitor prescriptions, but were 27% more likely to receive a diuretic prescription.

"Additional efforts need to be taken to ensure that everyone, women and men, who should receive cardiovascular medications are actually prescribed these medications," lead investigator Sanne Peters, PhD, research fellow in epidemiology at the George Institute for Global Health at the University of Oxford in the UK, and associate professor at the University Medical Center Utrecht in The Netherlands, said in a statement. "We also need to reduce the persistent treatment gaps between women and men."

With recent research indicating female heart attack survivors were less likely than men to receive recommended medications in a hospital setting, Peters and colleagues from the George Institute of Global Health designed the current study to focus on potential prescribing disparities in primary care settings among patients at high-risk or established cardiovascular disease.

Using PubMed and the Embase databases, investigators performed a search of studies published between 2000 and 2019 for observational studies examining sex-specific prevalence of certain cardiovascular medications.

Classes of cardiovascular medication examined in the search included aspirin, statins, and any antihypertensive medication such as beta blocks, ACE inhibitors, and diuretics. Investigators defined being high-risk or established cardiovascular disease as coronary heart disease, stroke, heart failure, and atrial fibrillation.

Exclusion criteria for the study included the study being published in a language other than English, including less than 1000 patients, reporting medication use for only 1 sex, assessing cardiovascular medication through self-report or pharmacy dispensing, and presenting an unrelated population, outcome, or not being performed in primary care.

The primary outcome of the study was the women-to-men prescription prevalence ratio for each medication. Secondary outcomes were sex-specific prescription rates of each medication.

Investigators assessed 900 different full-text articles for eligibility, of which 43 met the aforementioned criteria. Of these 43 studies, 18 examined aspirin, 30 examined statins, 21 examined beta-blockers, 21 examined ACE inhibitors, and 14 examined diuretics. Additionally, investigators pointed out 8 of the 43 examined high-risk patients, 24 examined patients with established cardiovascular disease, and 11 examined both.

Of note, from the 43 studies, investigators obtained cohort data related to 2,264,600 patients—28% of whom were women. The mean age of patients in studies ranged from 51-76 years.

Upon analysis, the pooled prevalence of cardiovascular prescription for women was 41% for aspirin 60% for statins and 68% for overall antihypertensive mediations. Among men, these rates were 56%, 63%, and 69%, respectively. Based on these results, investigators calculated women were 19% (Prevalence Ratio [PR], 0.81; 95% CI, 0.72-0.92) less likely to be prescribed aspirin and 10% (PR, 0.90; 95% CI, 0,85-0.95) less likely to be prescribed statins.

Additionally, results suggest women were less likely to be prescribed ACE inhibitors (0.85; 95% CI, 0.81-0.89) but more likely to be prescribed diuretics (PR, 1.27; 95% CI, 1.17-1.37). Of note, mean age, mean age difference between sexes, and year of study had no significant impact on findings.

This study, “Sex Differences in Cardiovascular Medication Prescription in Primary Care: A Systematic Review and Meta-Analysis,” was published online in the Journal of the American Heart Association.