Research has consistently shown that America’s healthcare system has a sexism problem, specifically when it comes to treatment in hospitals. Now, a new study, published in Women's Health Issues, is unique in that it sought to measure gender bias in emergency situations — for instance, first responders taking care of someone who has heart attack symptoms out of a hospital setting.
The findings from researchers from George Washington University mean that more women than men are put in life-threatening situations during emergency healthcare treatment. For instance, the study found men were more likely than women to receive aspirin, be resuscitated, or be taken to the hospital in ambulances using lights and sirens.
Melissa McCarthy, a professor of public health at George Washington University and senior author of the study, told Salon that while the disparities were relatively modest, they are nonetheless concerning for what they imply.
“Cardiovascular disease is the leading cause of death in women, and there have been gender disparities that are well-known in the hospital arena that have narrowed in recent years. [Those disparities] were so large finally the medical community took notice and narrowed that gap, but for heart attacks, most heart attack deaths occur before the person gets to the hospital,” she explained. “The results are positive in the sense that the disparities are small, but the high portion of patients who weren’t getting evidence-based therapies, and that they might be less likely to give it to women than men."
"Yes, there is some bias there," McCarthy concluded.
McCarthy and her colleagues analyzed data from the National Emergency Medical Services Information System (NEMSIS) database, a voluntary, national registry of EMS activations funded by the National Highway Traffic and Safety Administration. They focused on patients over the age of 40, those who have higher risks for heart disease, with chest pain or cardiac arrest. The dataset included approximately 2.4 million people, 1.2 million of them were women, across 46 states.
Overall, less than half of patients with chest pain, both men and women, received the recommended treatment with aspirin and cardiac monitoring.
“The low rate of aspirin administration we observed may be due to patient use before EMS arrival, daily aspirin use, or an allergy to aspirin," the authors noted.
For women, 2.8 percent less than men received aspirin, and 4.6 percent less than women were transported to the hospital using lights and sirens. For women who had cardiac arrest, the data showed they were 1.3 percent less likely to receive resuscitation from emergency medical workers than men, and 8.6 percent were less likely to receive cardiac defibrillation.
“We also cannot rule out the possibility that there is an under-appreciation of women's heart disease risk by EMS [emergency medical service] providers, particularly given that differences between the genders were larger for individuals less than 65 years old,” the report stated, calling for more research to ensure optimal treatment for all genders.
Indeed, this study is yet piece of evidence of how systemic sexism pervades America’s healthcare system, a symptom that has been observed throughout history (for example, Aristotle’s distinction between the male “form” and female “matter”). A study in November suggested that women are less likely to receive CPR from a bystander because they could be more reluctant to touch a woman’s chest, or be accused of sexual assault.
“The consequences of all of these major themes is that women will potentially receive no CPR or delays in initiation of CPR,” Sarah M. Perman, M.D., M.S.C.E., assistant professor of Emergency Medicine at the University of Colorado School of Medicine in Denver and lead author on the survey study, said in a statement. “While these are actual fears the public holds, it is important to realize that CPR is lifesaving and should be rendered to collapsed individuals regardless of gender, race or ethnicity.”
While misconceptions by the public are distressing, it is equally disconcerting that sexism appears to be evident among emergency service professionals.
"This study makes an important contribution to gender equity by identifying a type of care where more attention is needed," said Amita Vyas, PhD, MHS, an associate professor of prevention and community health at Milken Institute SPH, in a statement. "We know that women are less likely to receive some forms of evidence-based cardiac care from doctors and hospitals, and this study alerts us to the need to more closely examine care provided by EMS agencies, too."