Abstract Body (Do not enter title and authors here): Background
There remain significant gender inequalities in the delivery of healthcare. Third generation P2Y12 inhibitors (P2Y12i), Prasugrel and Ticagrelor, are the standard of care for dual antiplatelet therapy (DAPT), especially in the setting of acute coronary syndrome (ACS). We hypothesized that women are less likely to be prescribed 3^rd generation P2Y12i than clopidogrel, due to concealed gender inequalities.
Methods
We examined gender differences in post percutaneous coronary intervention (PCI) care in a cohort of 12,354 PCI cases from all 14 hospitals within the Steward Health Care system in the United States of America (USA). After removal of duplicates, 10,415 patients were included in the final analysis, with 7,191 males (69.04%) and 3,224 (30.96%) females. We conducted statistical analyses using the Chi-Square test of independence to explore associations between categorical variables, and logistic regression analysis to model the probability of clopidogrel prescription based on patient characteristics, adjusting for confounders.
Results
We found that women were less likely than men to be prescribed 3^rd generation P2Y12i compared to clopidogrel with an odds ratio (OR) of 0.74 (CI 0.69-0.80, p<0.001). We adjusted for the following variables: age, weight, insurance type, number of stents, and relevant co-morbidities. The association remained significant with an OR of 0.83 (CI 0.76-0.90, p<0.001). In a subgroup of ACS patients, the association was also statistically significant with an OR of 0.77 (CI 0.67-0.88, p<0.001).
Conclusions
Our study reveals that significant gender disparities exist in the prescription of P2Y12i after PCI, with women having a greater likelihood of being prescribed clopidogrel compared to more effective and guideline directed, 3^rd generation agents. This association held true after accounting for confounding variables including older age and an increased prevalence of co-morbidities in the female group. Our conclusions are likely to have been influenced by unmeasured socioeconomic factors, such as household income and medication costs. Therefore, further research ought to be conducted to better understand the reasons behind the association observed.