What happens when the medical caretakers are ill-equipped to care for your personalcaretakers？

The answer — so far — for the cardiovascular care of women and people of color has not been encouraging. Conscious or unconscious gender, racial and ethnic biases are adversely impacting their health on the whole. And the costs are staggering.

The recently-published white paper and supplemental information from“超越干预：患者经验和健康公平”survey of 1,289 people suffering from vascular diseases across 13 countries — along with 408 physicians and 173 healthcare leaders — found:

• Women with Coronary Artery Disease（CAD）和/或周围动脉疾病（软垫）与男性相比，与男性相比，有关医疗保健互动及其与医师关系的情绪因素，报告了更多具有挑战性的经历。
• 与白人男性患者相比，妇女和非白人患者不太可能被推荐并接受心脏导管插入术，尽管性别和种族不可能的临床指南，但¹与男性同行相比，临床结果和患者经历较差。多么贫穷？女性梗塞住院期间的总死亡率（心脏病发作）为16.7％，男性为11.5％。当看待50岁以下的患者时，女性的死亡率是男性的两倍。²
• 对于妇女而言，由于重复住院和缺席工作日，这些结果对医疗保健系统和工作场所的经济负担而言，这些结果的影响更大。^3,4

额外的情感和经济成本

Because women can present symptoms differently from men⁵- 这可能导致血管疾病被诊断和治疗未经诊断不足 - 超过一半的妇女提到很难找到认真对待她们的医生，从而导致缺乏对女性和有色人种的信任，获得和理解。

Fallout from the emotional toll is exacerbated by economic burdens.

• In a single year, the incremental total medical costs per U.S. person with angina/chest pain were $14,796, with incremental cardiovascular-specific costs of $10,949.20. Additionally estimated annual costs due to absenteeism and presenteeism totaled per-person of $13,977.
• 当美国劳动力中估计有150万缺血的人（INOCA）中，这种经济影响估计有150万人，没有阻塞性冠状动脉疾病（INOCA），每年估计的每年估计生产率损失成本可能高达210亿美元。⁴有50-70％的妇女出现Inoca，³仅妇女，这些费用可以达到105-147亿美元。

"Inherent biases can hinder a physician’s ability to detect and recognize symptoms, especially for populations that have been historically misdiagnosed in the cardiovascular disease setting, such as young, female and certain ethnicities," said Dr. Natalia Pinilla, Interventional Cardiologist at Hamilton Health Sciences/Niagara Health and Assistant Professor in the McMaster University Department of Medicine.

It's an emotional and economic toll that cannot be allowed to fester. At Abbott, we have a mission to恢复对医疗保健的尊严通过medical technology that’s affordable and accessible到2030年，我们了解复杂的问题需要多方面的解决方案来缩小这些妇女和有色人种的护理差距。

三个开始的地方

• Enrolling more临床数据研究中的代表样本, starting with more inclusive trial designs. Women account for only 38% of participants in cardiovascular clinical trials⁶尽管是美国人口的一半。⁷For Black women, the numbers are even starker: 2.9% of participants in clinical pharmaceutical drug trials between 2006 and 2020,⁸despite representing about 14% of the U.S. population,⁹其年龄调整的心脏病率比白人女性高72％。¹⁰
• 利用培训人工智能（AI）算法的全面和包容性数据集，这些算法将为患者提供未来的诊断和治疗决策。“基于AI的算法有多种方式，其核心可以偏见，”外科教授兼凯克医学院肢体保护计划主任David G. Armstrong博士说。加州南部。“我们正在尝试开发基于广泛的算法，以允许深入学习，而不仅仅是肤浅的，只专注于一种肤色。我们开始看到结果。”
• Increasing investments in women’s health, incorporating the spectrum of clinical trials grant funding and ranging to Female Technology (FemTech) solutions that can help with disease management. As the number of women at the forefront of digital research continues to grow, it's important to recognize that FemTech is not a "side project." Women who feel they have been failed by clinicians are taking control of their own conditions and treatment options. "Female investors tend to better understand challenges in women's health space because chances are they have experienced them, too," said Marija Butkovic, LLM, Founder/CEO of Women of Wearables. "Diversifying their teams internally, as well as portfolios, institutional investors have the opportunity to not only democratize access to better healthcare for all but also to change the narrative around what good accessible healthcare means and technology is a big part of that."

总解决方案：有意识的包容性

为了借助数字保健工具和筛选技术以及计算机辅助的数据审查，减少性别和种族差距，如果这些工具真正地使用代表所有人群的各种数据集，这些工具将最有效¹¹需要检查临床和经济决策中的个人偏见。

"The first step is to recognize physician and cultural bias in cardiovascular care and its socioeconomic and clinical impacts." said Dr. Nick West, Chief Medical Officer and Divisional Vice President of Medical Affairs, Abbott’s Vascular Business. "Only then can we begin to outline the necessary steps that must be taken to address the systemic issues underpinning underrepresentation, health inequity and ethnic/sex bias that are currently affecting patients suffering from vascular disease."

这就是我们所有人都想得到的答案。

参考

¹Lawton等人，“ 2021 ACC/AHA/SCAI冠状动脉血运重建指南：美国心脏病学学院/美国心脏协会临床实践指南联合委员会的报告”，流通。2021;144：00-00。
²Vaccarino等。“心肌梗塞后早期死亡率的基于性别的差异”，《新英格兰医学杂志》，1991年7月22日。
³Kunadian V, Chieffo A, Camici PG, et al. An EAPCI Expert Consensus Document on Ischaemic with Non-Obstructive Coronary Arteries in Collaboration with European Society of Cardiology Working Group on Coronary Pathophysiology & Microcirculation Endorsed by Coronary Vasomotor Disorders International Study Group. European Heart Journal. 2020; 0:1-21.
⁴Schumann CL, Mathew RC, Dean J-HL et al. Functional and economic impact of INOCA and influence of coronary microvascular dysfunction. JACC Cardiovascular Imaging 2021; 14: 1369-79.
⁵Mehta等人，“心血管医学中的性别：胸痛和冠状动脉疾病”，《欧洲心脏杂志》（2019）40，3819-3826。
⁶Ibid.
⁷世界银行，2020年，“人口，女性（占人口的百分比） - 美国”。
⁸M.D. Siliang Chen和M.D. Jiarui Li，“黑人美国居民参与24种授予FDA批准的心血管药物的临床试验，2006-2020”，JAMA Network，2021年3月23日。
⁹Tamir, et al., "Facts About the US Black Population," Pew Research Center, March 25, 2021.
¹⁰“妇女和心脏病事实”，妇女心脏协会。
¹¹约翰联盟（John League），“关于卫生保健中人工智能现实的5个问题”，2022年1月18日。