GENDER DIFFERENCES IN HEALTHCARE UTILISATION: CAUSAL EVIDENCE FROM UNEXPECTED ADVERSE HEALTH SHOCKS
Author(s)
Nadja van 't Hoff, PhD in Economics1, Giovanni Mellace, PhD in Economics2, Seetha Menon, PhD3.
1VU University Amsterdam, Amsterdam, Netherlands, 2University of Southern Denmark, Odense, Denmark, 3Odense, Denmark.
1VU University Amsterdam, Amsterdam, Netherlands, 2University of Southern Denmark, Odense, Denmark, 3Odense, Denmark.
OBJECTIVES: To examine whether men and women receive different levels of healthcare following major cardiovascular health shocks and to identify the mechanisms underlying any disparities. Specifically, we investigate gender differences in post-event healthcare utilisation, prescription drug use, and health outcomes after first-time non-fatal heart attacks and strokes in a universal healthcare system.
METHODS: We use nationwide Danish administrative register data covering first-time non-fatal heart attacks and strokes between 1995 and 2018. The analysis focuses on individuals aged 50-70 with low pre-event cardiovascular risk. Dynamic treatment effects are estimated using a staggered difference-in-differences design, complemented by matching and triple-difference specifications to compare post-shock healthcare responses across genders. Outcomes include primary-care utilisation, prescription medication use, and mortality.
RESULTS: Cardiovascular health shocks substantially increase healthcare utilisation for both men and women. However, men experience significantly larger increases in secondary-prevention pharmacotherapy and primary-care use. Gender differences are largest for medications requiring greater clinical discretion, including statins, beta blockers, and ACE inhibitors, while differences are minimal for antiplatelet therapies. Additional analyses suggest that these disparities arise primarily from differences in prescribing intensity rather than medication adherence or healthcare-seeking behaviour. Despite differences in treatment intensity, we find no meaningful gender differences in short- or long-run mortality following the health shock.
CONCLUSIONS: Gender disparities persist within a universal healthcare system even after individuals enter care following serious cardiovascular events. The evidence suggests that differences are concentrated in treatment decisions requiring greater provider discretion, pointing to prescribing practices as a key mechanism. These findings highlight the importance of understanding how clinical decision-making contributes to gender inequalities in healthcare.
METHODS: We use nationwide Danish administrative register data covering first-time non-fatal heart attacks and strokes between 1995 and 2018. The analysis focuses on individuals aged 50-70 with low pre-event cardiovascular risk. Dynamic treatment effects are estimated using a staggered difference-in-differences design, complemented by matching and triple-difference specifications to compare post-shock healthcare responses across genders. Outcomes include primary-care utilisation, prescription medication use, and mortality.
RESULTS: Cardiovascular health shocks substantially increase healthcare utilisation for both men and women. However, men experience significantly larger increases in secondary-prevention pharmacotherapy and primary-care use. Gender differences are largest for medications requiring greater clinical discretion, including statins, beta blockers, and ACE inhibitors, while differences are minimal for antiplatelet therapies. Additional analyses suggest that these disparities arise primarily from differences in prescribing intensity rather than medication adherence or healthcare-seeking behaviour. Despite differences in treatment intensity, we find no meaningful gender differences in short- or long-run mortality following the health shock.
CONCLUSIONS: Gender disparities persist within a universal healthcare system even after individuals enter care following serious cardiovascular events. The evidence suggests that differences are concentrated in treatment decisions requiring greater provider discretion, pointing to prescribing practices as a key mechanism. These findings highlight the importance of understanding how clinical decision-making contributes to gender inequalities in healthcare.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
MSR185
Topic
Methodological & Statistical Research
Topic Subcategory
Confounding, Selection Bias Correction, Causal Inference
Disease
Cardiovascular Disorders (including MI, Stroke, Circulatory)