5 Things About Gender Disparities in Care to Remember as National Women's Health Week Ends

Terry Kohl, a real estate agent in New Jersey, battled what she thought was indigestion for 6 months and went repeatedly to a gastroenterologist for what she thought was a case of “grumbly gut.”

Now 72, it wasn’t until she went to Rome to sing for Pope Francis with her church choir in 2015 that she realized she was short of breath climbing hills. Upon returning home, her internist sent her to a cardiologist. Three days later, she was having a triple bypass.

“I wasn’t ever thinking of my heart,” said Kohl, who underwent cardiac rehabilitation and is doing fine today.

As National Women’s Health Week comes to a close, here are 5 ways women experience health and healthcare differently than men.

1. Heart Disease

Think of a disease that targets women and breast cancer leaps to mind. However, heart disease affects more women. According to the American College of Cardiology (ACC), 1 in 3 women will develop heart disease at some point in their lifetime, versus 1 in 8 for breast cancer.

Kohl’s missed symptoms are not uncommon, according to the ACC, which said women experience different warning signs of heart trouble than men, including nausea, dizziness, stomach pain, indigestion, trouble sleeping, fatigue, and more.

For women, the risk of heart failure rises after menopause and escalates even more after age 65; according to data from ACC, women aged 75 to 84 years are 3 times more likely to have heart failure than those aged 65 to 74.

Compounding the problem is that even though both sex and gender differences in cardiovascular disease (CVD) and its treatments have been well documented, women continue to be less represented than men in clinical trials of drugs to treat CVD. Among proposed reasons for this phenomenon are the recruitment of younger patients, inclusion criteria that tend to select men, and exclusion criteria that are more common in women.

ACC also said women are less likely to receive the same advice, guideline-recommended treatments, and aggressive interventions as men. Women are also less likely to take part in cardiac rehabilitation after a heart attack.

2. Cost of Healthcare

The impact of high healthcare costs is felt by both sexes, but according to a recent survey from the Kaiser Family Foundation (KFF), the burden falls most heavily on women. On average, women earn lower wages, have fewer financial assets, accumulate less wealth, and have higher rates of poverty.

KFF's findings include:

• 1 in 4 (26%) women versus 1 in 5 (19%) men have had to delay or forego care in the past year due to cost
• 1 in 5 women have postponed preventive care (19%), skipped a recommended test or treatment (20%), or made medication tradeoffs such as not filling a prescription or cutting dosages (17%) because of cost
• 1 in 4 women report that they have had problems paying medical bills (25%) in the prior year and 1 in 3 are currently paying off medical bills (33%)

The Affordable Care Act (ACA) has helped to reduce the rate of uninsured women. In 2013, the KFF women’s health survey found nearly 1 in 5 non-elderly women were uninsured, but by 2017, this had dropped to 1 in 10. However, uninsured rates are higher among subgroups of women, particularly those who are low-income and Latina.

The ACA covers preventative services for women, which can help reduce healthcare costs for most women with insurance, including contraception, preventative healthcare (well-woman visits), sexually transmitted infection counseling, cervical cancer screenings, HIV screenings, breast cancer screenings, and domestic violence screening.

3. Reproductive Healthcare

Abortion is increasingly concentrated among poor women, according to the Guttmacher Institute. It remains a common medical procedure (1 in 4 women will have an abortion by the age of 45, according to Guttmacher), but the rate has fallen to historic lows for 2 reasons: improved access to contraception and increased restrictions, which will tighten with Friday’s announcement by the Trump administration of the reinstatement of the so-called “gag rule.”

Opposed by the American College of Obstetricians and Gynecologists, the American College of Physicians, and other medical organizations, the reinstatement of the Title X rule means that healthcare providers receiving federal funds cannot refer patients about where to receive abortions. The ruling is aimed at Planned Parenthood, which does not receive federal funding for abortions, but does receive Medicaid funding for other healthcare services covered under the ACA. The Hill reported that the announcement was made by HHS in a private conference call with opponents of abortion.

4. Respiratory Diseases

Respiratory diseases, such as asthma and chronic obstructive pulmonary disease (COPD), are known to affect women differently than men because of metabolic and hormonal factors.¹

Asthma is affected by female hormones throughout life, starting at puberty. Women have more frequent and severe asthma symptoms, poorer quality of life, greater healthcare utilization, are more likely to be hospitalized, and a higher death rate. Early-onset menarche may increase the risk of asthma for some women because of greater cumulative estrogen and progesterone. The onset of menstruation may also worsen asthma for about 30% to 40% for some women. Older women on hormone replacement therapy may see their asthma worsen, as well.

COPD is an incurable, progressive lung disease that was most recently in the news for taking the life of former First Lady Barbara Bush. COPD prevalence is increasing more rapidly in women, particularly in younger women, and COPD-related hospitalizations and deaths in women also surpass men. A report from the American Lung Association said more than 7 million women have COPD, and millions more have symptoms but have not been diagnosed. Women also predominate the roughly 25% of nonsmokers with COPD.

Women are more vulnerable to the effects of tobacco smoke due to estrogen impacts or because of other biological factors, such as shorter height and reduced lung size. They are also more likely to be misdiagnosed by providers and have a delayed diagnosis.

5. Mental Illness

Mental health disorders are the leading cause of disability in the United States, and women suffer from depression twice as much as men. Men and women respond to depression treatment differently due to biological, molecular, and other factors. Depression, especially at midlife and beyond, is a risk factor for later dementia, which also affects women in greater numbers.²

As with other healthcare issues, women may also have more trouble accessing mental health care after a divorce or other life change.

In veterans, females report chronic pain more often than males, and post-traumatic stress disorder (PTSD) also affects women and men differently. Women are more than twice as likely to develop PTSD than men, possibly because they are more likely to experience sexual assault—the most common type of trauma for women, affecting about 1 in 3 women.

References

1. Han MK, Arteaga-Solis E, Blenis J, et al. Female sex and gender in lung/sleep health and disease: increased understanding of basic biological, pathophysiological and behavioral mechanisms leading to better health for female patients with lung disease. [published online May 10, 2018]. Am J Respir Crit Care Med. doi: 10.1164/rccm.201801-0168WS

2. Kaup AR, Byers AL, Falvey C, et al. Trajectories of depressive symptoms in older adults and risk of dementia. JAMA Psychiatry. 2016;73(5):525-531. doi:10.1001/jamapsychiatry.2016.0004