Gender disparities in delayed angina diagnosis: insights from 2001–2020 NHANES data

Abstract Background Women with coronary artery disease (CAD) are more likely than men to experience a delay in diagnosis, which is attributed to differences in clinical presentation. The objective of this study is to examine any persistent disparities in timely CAD diagnosis in the United States (U.S.) among women who present with clinically similar symptoms and demographic characteristics to their male counterparts. Methods From the 2001 – 2020 National Health and Nutrition Examination Survey (NHANES) data, participants were categorized as having missed angina if they experienced angina and did not self-report a prior diagnosis of angina pectoris or CAD. We assessed the association between gender and missed angina using weighted multivariate logistic regression models representative of the U.S. population. Mortality follow-up data were available for participants up to December 31, 2018. Results Of 874 participants with missed angina, 551 (63%) were women and 323 (37.0%) were men. Baseline characteristics showed that women and men with missed angina were more likely than their diagnosed counterparts to be younger, of ethnic minorities, uninsured, and smokers. Women with missed angina were more likely to be in a relationship than diagnosed women, while the opposite pattern was observed in men. The odds ratio of missed angina in women compared to men was 2.61 (95% CI: 1.73, 3.94) after adjusting for age, race, education, body mass index, smoking, alcohol use, income, insurance, and comorbidities. Among participants who had a cardiac cause of death, the odds of missed angina in women compared to men was 3.02 (95% CI: 1.18, 7.75) in the adjusted model. Conclusion Women with similar CAD symptoms to their male counterparts still have higher odds of going undiagnosed. This relationship extends to individuals who ultimately die of cardiac causes. Potential solutions to this disparity include addressing overgeneralized perceptions of differences in the prevalence and presentation of CAD between genders and exploring targeted screening programs for women with risk factors. Further research accounting for healthcare access and proximity to care is needed to support our findings. Timely recognition of CAD in women is essential to decreasing preventable mortality.