of estrogen replacement therapy, calcium supplementation, and exercise in preventing osteoporosis and fractures in postmenopausal women.2
Another type of information deficit occurs for conditions that affect both women and men. These conditions include the leading causes of death in both sexes (cardiovascular disease and lung cancer3) as well as conditions that are more prevalent in women (e.g., depression) or that affect men and women differently (e.g., AIDS). Exclusion of women from clinical studies of this class of conditions, or inclusion of women in numbers too small to detect gender differences or to support subgroup analyses, may result in a "male model" of medical treatment that is inappropriate for women.4 Both biological and psychosocial differences between the sexes may affect etiology, risk factors, disease presentation, disease course, or responses to preventive interventions or treatments. For example, there are numerous information deficits for prevention and treatment of heart disease in women, in part because women were excluded from a number of key trials (e.g., the Lipid Research Clinics Coronary Primary Prevention Trial, the Multiple Risk Factor Intervention Trial, and the Physicians' Health Study). The efficacy of hormone replacement therapy in prevention of heart disease in women is one question requiring further research.5
If there were overall negative health consequences to women as a result of information deficits, we would expect to see them reflected in gender differences in morbidity and mortality; in gender differences in patterns of diagnosis and treatment for key conditions; in gender differences in survival or outcomes of treatments; or in providers' perceptions that their ability to provide optimal care to women patients is compromised. We will examine each of these briefly.
Although average life expectancy for U.S. women is about 7 years longer than for men, women consume more health services (including prescription drugs) than men, and throughout life, women experience more disease and disability than men.6 Further, because women live longer than men, they are more likely to be affected by late-onset diseases such as Alzheimer's disease and osteoporosis.
Mortality trends reveal some interesting gender differences. Although mortality rates from cardiovascular disease have been declining for both sexes over the last two decades, the decline in deaths from ischemic heart disease has been slower for women than for men.7 In addition, some of the key risk factors for heart disease (e.g., smoking, elevated serum cholesterol, obesity) have not