Gender Bias in Stroke Care

Gary E Cordingley, MD, PhD
In this day and age you would think that medical care provided to women would
be as good as that provided to men. But think again--evidence suggests otherwise.
I can't think of any adequate excuse for women to receive medical care that is less good than that which is
received by men. However, evidence for this continues to surface. The latest study to demonstrate this
unsettling fact was published in the September 27, 2005, issue of Neurology, the official journal of the
American Academy of Neurology. Melinda Smith and co-investigators looked at stroke care between 2000
and 2002 in the seven acute-care hospitals of Corpus Christi, Texas, which includes all of the hospitals of
Nueces County.

Patients hospitalized for stroke, a condition in which interrupted circulation causes damage to the brain,
should receive a core battery of testing. Every stroke patient should receive an echocardiogram, a
soundwave-based test that shows images of the heart and its various components in motion. This is useful in
showing if the heart might have generated the stroke by sending clots or other material into the circulation
feeding the brain, and also to identify complications affecting the heart itself. Moreover, patients believed to
have a stroke to the front part of the brain (which applies to most cases) should receive testing for narrowing
or blockage of the carotid arteries. The carotids are the two pulsating blood-vessels in the front of the neck
which convey blood to the front of the brain.

The researchers found that while 57% of the men with strokes received an echocardiogram, this test was
given to just 48% of the women with strokes. And while 71% of the men received carotid imaging, this test
was provided to just 62% of the women. Statistics showed that these differences were too large to account
for by chance alone. Moreover, the researchers diligently searched for legitimate medical reasons to
account for the unequal testing--like differences in stroke risk-factors or differences in recognition that a
stroke had occurred--but found that these could not account for the differences, either.

In truth, the extent of testing in even the men fell below standards of care--and probably does so in other
communities as well--but for the current discussion, the emphasis is on the differences in care provided to
the two genders.

So, if these results can be generalized to practices elsewhere, the sad truth is that if you are a woman with a
stroke, your care will not be as good as if you are a man. And, unfortunately, the gender bias in stroke care
demonstrated by these researchers was not an isolated example. The authors reviewed the results of other
studies that showed:

  • Sixty-two percent of stroke deaths in the United States occur in women.
  • Women have a lower incidence of stroke but worse outcomes than men.
  • One hospital's study showed that in their emergency department women with strokes were evaluated
    less quickly than men with strokes were.
  • A multinational, hospital-based study showed fewer brain-imaging, heart-imaging and blood-vessel-
    imaging studies in women than in men.
  • Women with strokes were less likely to receive blood-thinners than men were.
  • And, women were less likely to receive surgery to the carotid arteries than men were.

What is more, gender differences in medical treatment of coronary artery disease have also been
demonstrated in Corpus Christi and elsewhere. So, as indicated by the authors, gender differences in
medical care probably extend beyond the evaluation and treatment of strokes.

One conclusion is unavoidable: The medical community still has a long way to go in providing equal care to
all the patients entrusted to its care.

(C) 2005 by Gary Cordingley