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Original Articles

Sex and Gender Discrepancies in Health-Related Quality of Life Outcomes Among Patients With Established Coronary Artery Disease

Colleen M. Norris, MSc, PhD; John A. Spertus, MD, MPH; Louise Jensen, MN, PhD; Jeff Johnson, PhD; Kathleen M. Hegadoren, MSc, PhD; William A. Ghali, MD, MPH for the APPROACH Investigators

From the University of Alberta (C.M.N., L.J., J.J., K.M.H.), Edmonton, Alberta, Canda; Mid America Heart Institute (J.A.S.), University of Missouri, Kansas City, Mo; and University of Calgary (W.A.G.), Calgary, Alberta, Canada.

Correspondence to Colleen M. Norris, PhD, 4-130F Clinical Sciences Building, University of Alberta, Edmonton, Alberta T6G 2G3. E-mail colleen.norris{at}ualberta.ca

Received May 23, 2008; accepted September 24, 2008.

Background— Although eradicating discrepancies in health is of unquestioned importance, there are few studies examining health-related quality of life (HRQOL) among men and women with coronary artery disease (CAD), a highly prevalent and morbid condition among industrialized nations. This study compares the HRQOL outcomes of men and women in Alberta, Canada, 1 year after the documentation of coronary artery disease by cardiac catheterization.

Method and Results— Patients’ disease-specific HRQOL was assessed 1 year after angiography using the Seattle Angina Questionnaire, whereas their generic health status, burden of depressive symptoms, and social support were respectively quantified with the EuroQol EQ-5D, the Center for Epidemiological Studies Depression Scale (short form), and the Medical Outcomes Study social support scale. The latter 2 instruments were used to adjust Seattle Angina Questionnaire outcomes for potential confounding characteristics hypothesized to be associated with sex and gender. General linear modeling and a change in Seattle Angina Questionnaire scores from baseline to 1 year were used to compare the HRQOL outcomes of men and women, after adjusting for demographics, clinical factors, depressive symptoms, and social support differences between groups. A total of 2394 (60% of those eligible) patients responded to the baseline and the 1-year follow-up survey. The adjusted mean 1-year Seattle Angina Questionnaire scores were significantly higher in men when compared with women, even after adjustment for all clinical factors, social support, depressive symptoms, and baseline HRQOL scales. Not only were women noted to have worse health status at the time of angiography, but despite adjusting for these differences, residual discrepancies in 1-year health status persisted.

Conclusions— Women with coronary artery disease report worse HRQOL 1 year after coronary angiography when compared with men, and the discrepancies observed are only partially accounted for by sex differences in depression and social support. As a result, the measurement of gender roles and perceptions may be the best place to persist on the quest to identifying and understanding the noted discrepancies in cardiac recovery and HRQOL outcomes.

Key Words: atherosclerosis • women • gender • sex differences • outcomes research • health-related quality of life

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