Institutional and attitudinal factors involved in higher mortality of Israeli women after coronary bypass surgery: Another case of gender bias

Despite their lower cardiovascular risks, women have higher case-fatality ratios after myocardial infarction (MI) and cardiac surgery. Along with women's older age and co-morbidity, this reflects gender bias in the timely diagnosis and treatment of heart disease in many western countries. Drawing on the theoretical framework offered by McKinlay (1996), current study examined attitudes and practices contributing to late diagnosis and substandard treatment of cardiac symptoms in women. Personal interviews were conducted with 30 women and 25 men sampled via the data set of the national survey of coronary bypass operations in Israel in 1994. In this survey, women's post-operative mortality has been found to be double that of men, also after adjustment for age and socio-economic factors. Interviews with the survivors helped elucidate some non-biological causes for female mortality disadvantage. Women's accounts confirmed that primary practitioners often denied cardiac nature of symptoms presented by women and delayed their referral for in-depth testing and intensive treatment, while no such delays occurred with men presenting with similar complaints. Gender bias was stronger during the initial diagnostic process and gradually abated after women were labeled as 'cardiac cases' and referred for intensive treatment. At all stages of their 'cardiac career,' women received less support from their family members than did men. However, women's own beliefs about their low cardiac risks and the primacy of family roles over health concerns may have also contributed to later diagnosis and poorer prognosis in women.