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Sex Differences in Health Care-seeking Behavior for Acute Coronary Syndrome in a Low Income Country, Peru

Pastorius Benziger, Catherine MD*†; Bernabe-Ortiz, Antonio MD, MPH; Miranda, J. Jaime MD, MSc, PhD; Bukhman, Gene MD, PhD

Critical Pathways in Cardiology: A Journal of Evidence-Based Medicine: June 2011 - Volume 10 - Issue 2 - p 99-103
doi: 10.1097/HPC.0b013e318223e375
Original Article

Objective: Recognizing reasons for prehospital delay after symptoms of acute coronary syndrome (ACS) is established in developed countries yet evidence from Latin America is limited. We aimed to assess ACS symptom recognition, health care-seeking behavior, and confidence in local health care facilities to take care of ACS by gender in a sample of Peruvians.

Methods: A community-based interview survey in a peri-urban area in Lima, Peru. The 24-item study instrument included vignettes and questions assessing identification of urgent and emergent ACS symptoms, anticipated help-seeking behaviors, and confidence in local health care facilities.

Results: In the study population (90 people; 45.6% men; mean age, 43.5 years), women were 4 times less likely to correctly attribute symptoms of chest pain to the heart (OR = 0.23; 95% CI: 0.063–0.87; P = 0.03). Women were much more likely to respond that a man would “Seek help” (OR = 4.54; 95% CI: 1.21–16.90; P = 0.024) and that “Yes,” a woman would be less likely to seek help for chest pain symptoms (OR = 3.26; 95% CI: 1.13–9.41 P = 0.029) after adjusting for age, education level, age at migration, and history of chest pain. Women were less likely than men to think that their local Health Care Post would help them if they had a heart attack (2.1% vs. 14.6%; P = 0.04), and only 18.7% of women believed that their local emergency room would help them.

Conclusions: Our findings suggest women are less likely to seek help for chest pain and women and men in a peri-urban area in Peru are not confident in their local health care facility to treat urgent or emergent ACS symptoms.


From the *University of Minnesota Medical School, Minneapolis, MN; †CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru; and ‡Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA.

The authors declare that they have no competing interests.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (

Reprints: J. Jaime Miranda, MD, MSc, PhD, CRONICAS Center of Excellence for Chronic Diseases. Universidad Peruana Cayetano Heredia, Lima, Peru. E-mail:

© 2011 Lippincott Williams & Wilkins, Inc.