Abstract
Women live longer than men but report more illness, possibly because of greater use of preventive health care, which leads to increased diagnosis. This hypothesis was tested in the Alameda County Study cohort consisting of 885 men and 1,058 women who did not report chest pain or heart trouble in 1965 and who were followed for new reports of these conditions during 1973–1974, and mortality through 1988. Contrary to expectations, preventive health care use was not associated with subsequent reports of chest pain or heart trouble for women. However, having a preventive checkup in the past year was associated with more than a 50% reduction in subsequent reports of chest pain (p <.001) and heart trouble (p =.06) for men. Similarly, possession of health insurance (an indicator of access to health care) was associated with a reduction of reported chest pain in men (p =.02) but not women. Gender differences in associations were significant and independent of other predictors of heart disease. Having a regular physician or clinic was not associated with subsequent reports of chest pain or heart trouble for either sex. These findings are not consistent with the hypothesis that high rates of preventive care use cause women to be diagnosed more often, and thus to report more heart disease morbidity. Results suggest gender differences in the content of preventive care and missed intervention opportunities for women.
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