Clinical Briefs
By Louis Kuritzky, MD
Differences Between Men and Women in the Rate of Use of HNA
Gender discrimination has been suggested to have played a role in the use of a variety of medical and surgical procedures, including coronary revascularization and renal transplantation, but the data are inconclusive since gender differences for disease prevalence, contraindications to surgery, and personal preference are scanty and may have an important effect.
Hip and knee arthroplasty (HNA) improve symptoms and reduce disability in persons with advanced arthritic disease. Although more women than men undergo HNA, these data are confounded by the fact that women demonstrate a higher incidence of hip and knee arthritis, as well as osteoporotic hip fracture. The intention of this report was to evaluate whether gender differences exist as far as need for, or willingness to undergo, arthroplasty are concerned.
Women were slightly more likely than men to report chronic hip or knee problems (OR = 1.16). Despite the greater self-reported osteoporosis and arthritis among women, they were less likely than men to have undergone HNA (OR = 0.78). Women reported having discussed HNA with their physician less often than men (32% vs 42%), and this gender disparity persisted when adjusted for age and disease severity.
In Hawker and colleagues’ final analyses, they conclude that though HNA is underused by both genders, underuse is more substantial for men than women. The fact that women appear to initiate discussion about their arthritis or seek a surgical solution less often than men, may be part of the explanation for the observed disparities.
Hawker GA, et al. N Engl J Med 2000; 342:1016-1022.
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