Being treated by a female physician associated with lower risk for death

Embargoed for release until 5:00 p.m. ET on Monday 22 April 2024    
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Below please find summaries of new articles that will be published in the next issue of Annals of Internal Medicine. The summaries are not intended to substitute for the full articles as a source of information. This information is under strict embargo and by taking it into possession, media representatives are committing to the terms of the embargo not only on their own behalf, but also on behalf of the organization they represent.    
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1. Being treated by a female physician associated with lower risk for death

Abstract: https://www.acpjournals.org/doi/10.7326/M23-3163    

URL goes live when the embargo lifts      

An observational study of more than 700,000 male and female patients found that patients treated by female physicians experienced lower mortality and readmission rates compared to patients treated by male physicians. The authors also found that these effects were amplified in female patients treated by female physicians. The study is published in Annals of Internal Medicine.

Researchers from the University of Tokyo conducted a retrospective observational study of Medicare patients aged 65 years or older who were hospitalized during 2016 to 2019 and treated by hospitalists to examine whether the association between physician sex and hospital outcomes varied between female and male patients. Of 458,108 female and 318,819 male patients, 142465 (31.1%) and 97,500 (30.6%) were treated by female physicians, respectively. The authors found that in addition to the lower mortality and readmission rates for male and female patients treated by female physicians, the difference between female and male physicians was especially large and clinically meaningful for female patients. The authors note that for female and male patients, length of stay, Part B spending, proportion of intensive evaluation and management claims, and likelihood of discharge to home did not differ between male and female physicians. According to the authors, there may be several reasons for this notable difference in care: male physicians may underestimate illness severity among female patients; being treated by female physicians may be associated with patient-centered and effective communication among female patients; and treatment by female physicians may help alleviate embarrassment, discomfort, and sociocultural taboos during sensitive examinations and conversations for female patients.

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with the corresponding author, Atsushi Miyawaki, MD, PhD, please contact amiyawaki@m.u-tokyo.ac.jp

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2. ACP recommends an evidence-based public health approach to excessive alcohol use 

Abstract: https://www.acpjournals.org/doi/10.7326/M23-3434  

URL goes live when the embargo lifts     

Policymakers and public health officials have a critical role to play in reducing excessive alcohol use and alcohol use disorder, says the American College of Physicians in a new policy published today.  Excessive Alcohol Use and Alcohol Use Disorders: A Policy Brief of the American College of Physicians, published in the Annals of Internal Medicine, says that barriers need to be removed to accessing treatment and more needs to be done to reduce binge drinking and heavy drinking among young adults and other high-risk populations. 

In the new paper ACP reiterates that alcohol use disorder is a treatable chronic medical condition that should be addressed through evidence-based public health and health care initiatives. Among the recommendations, ACP supports training and payment and delivery system policies that would better enable physicians and other qualified health professionals to screen, diagnose and treat patients. ACP also supports the implementation of evidence-based public health strategies to reduce excessive alcohol use and alcohol use disorder and emphasizes the need for them to be sufficiently funded. Finally, ACP calls on regulators, community groups, educators, and the alcohol industry to make a concerted effort to reduce underage alcohol use. 

April is Alcohol Awareness Month.  This public health program is organized by the National Council on Alcoholism and Drug Dependence to increase understanding and awareness of alcohol use disorder. 

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with someone from ACP, please email Jacquelyn Blaser at jblaser@acponline.org.  

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3. Historical redlining associated with higher rate of firearm fatalities

Abstract: https://www.acpjournals.org/doi/10.7326/M23-2496    

Editorial: https://www.acpjournals.org/doi/10.7326/M24-0870  

URL goes live when the embargo lifts      

An analysis of neighborhoods historically designated as low-rated for creditworthiness (known as “redlining”) in more than 200 U.S. cities found that these neighborhoods experienced a much higher rate of nonsuicide firearm fatalities between 2014 and 2022. The analysis is published in Annals of Internal Medicine.

Researchers from Boston Children’s Hospital, Boston Medical Center, and Harvard T.H. Chan School of Public Health analyzed historical maps of neighborhoods created by the federally-funded Home Owners’ Loan Corporation (HOLC), an organization that graded neighborhoods as eligible for receiving housing and insurance services based, in part, on the percentage makeup of “foreign-born,” “Negro,” “infiltration,” and “relief families.” This practice excluded persons in these demographic designations from receiving housing and insurance services. The authors found that these historically-defined neighborhoods experienced disparate rates of nonsuicide firearm deaths between 2014 and 2022. In areas designated “hazardous” 80 years ago, firearm fatalities are nearly 6 times more likely to occur today than in areas designated “best.” However, the authors note that results demonstrate heterogeneity across the country, such that not all cities exhibit equal inequities in gun violence related to HOLC area.

In an accompanying editorial, authors from the University of Pennsylvania emphasize that while research related to firearm injury is very important, they wonder if further comparisons of HOLC maps with firearm violence will offer new and useful insights to researchers, policymakers, and community activists working to reduce firearm violence. They suggest that researchers should use HOLC maps not merely as a basis for research, treating history as an independent variable, but rather as an evidence-based backdrop that fundamentally alters our perception and understanding of the contemporary experience of individuals most affected by firearm violence exposure, and of the places inundated day in and day out by its hazards.

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with the corresponding author, Ayesha Dholakia, MD, please contact Boston Children’s Hospital Media Relations at media.relations@childrens.harvard.edu.

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4. Firearm violence risk score may help tailor, disseminate prevention efforts in emergency departments

Abstract: https://www.acpjournals.org/doi/10.7326/M24-0026    

URL goes live when the embargo lifts      

A four-item score designed to predict those at risk for future firearm violence may serve as an important tool for emergency department clinicians to tailor interventions to young persons at risk for firearm violence and disseminating those interventions effectively. A new cross-sectional analysis of the association between the risk score and self-reported firearm violence is published in Annals of Internal Medicine.

Researchers from the University of Michigan, University of Pennsylvania, and University of Washington conducted a cross-sectional study of persons aged 18 to 24 years appearing in emergency departments in Flint, Michigan, Philadelphia, Pennsylvania, and Seattle, Washington between 2021 and 2023 to estimate the association between the SaFETy score and past 6-month self-reported firearm violence. The SaFETy score was derived and internally validated in a previous sample of substance-using youth, and is the only clinical screening tool specific to firearm violence. Thisten-point score comprised of four items: fighting; friend weapon carrying; hearing gunshots in one’s neighborhood; and receiving firearm threats. The authors found that persons with higher SaFETy scores showed a higher prevalence for firearm violence within the past six months than participants with a low score. According to the authors, their findings indicate that the score may be important for preventive resource allocation and to ascertain persons with firearm violence history.

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with the corresponding author, Jason E. Goldstick, please contact Kate Williams at katebarn@umich.edu.

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5. System-level factors influence doctors to reduce low-value care practices

Abstract: https://www.acpjournals.org/doi/10.7326/M23-1456    

Editorial: https://www.acpjournals.org/doi/10.7326/M24-0862  

URL goes live when the embargo lifts     

A study analyzing Medicare data on low-value care (LVC) services, or services that provide little to no benefit relative to their potential cost, found that physicians were more strongly influenced by system-level factors that encourage a reduction of LVC and more resistant to factors that encourage an increase in LVC. In other words, physicians moving to locations with lower rates of LVC were more likely to adopt those practices, but the opposite was not true. The findings are published in Annals of Internal Medicine.  

Researchers from the University of Utah studied Medicare claims data for matched physician-patient groups comprised of 8,254 physicians and 56,467 patients for two services that can have low value—prostate-specific antigen (PSA) testing and mammography screening—in fee-for-service Medicare beneficiaries aged 75 years or older. The goal was to determine if system-level factors would influence LVC. The researchers compared LVC rates for physicians staying in their original service area and those relocating to new areas. They found that physicians who relocated to a new service area with lower rates of LVC started to practice more like physicians in that new area. Further, the researchers observed a dose–response effect in which physicians who relocated from high- to medium-LVC areas provided more LVC than those who relocated to low-LVC areas but less than those who stayed in high-LVC areas. The authors note that this pattern was not noticed among physicians relocating from low- to higher-LVC areas.  

The authors of an accompanying editorial from Dartmouth College and Brigham and Women’s Hospital say that if there are ways to both reduce spending and improve quality of care and patient experience, they should be quickly adopted. The study shows what might happen when physicians assimilate in a new environment and highlights the complex interplay among system, clinician, and patient factors in LVC use and solutions. 

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with the corresponding author, Kassandra Dindinger-Hill, BS, please email dindi003@umn.edu.

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