Gender differences in the utilisation of surgery for congenital heart disease in India

Sivasubramanian Ramakrishnan, Rohan Khera, Snigdha Jain, Anita Saxena, Suparna Kailash, Ganesan Karthikeyan, Shyam S. Kothari, Rajnish Juneja, Balram Bhargava, Mani Kalaivani, Manju Mehta, Vinay K. Bahl, Balram Airan

Research output: Contribution to journalArticlepeer-review

34 Scopus citations


Background: Corrective surgery for congenital heart disease may be life-saving, but its utilisation depends upon several social and economic factors. Girls with cardiac defects may not receive equitable care in India, but this has not been systematically studied. Methods: In this prospective study, parents or guardians of 405 consecutive children aged up to 12 years (mean±SD age 3.43±3.44 years; 271 boys) who had been advised to undergo elective paediatric cardiac surgery were interviewed using a validated questionnaire. The status of the patients was reviewed after a year and the factors associated with non-compliance with treatment were analysed. In a qualitative sub-study the parents of 20 children who had not undergone surgery were interviewed. Qualitative data were analysed using an inductive analytical approach. Results: Of the 405 patients studied, 44% (59/134) of girls had undergone surgery at 1 year compared with 70% (189/271) of boys (χ 2=24.97; p<0.001). Independent predictors for non-compliance with surgery included female gender (OR 3.46, 95% CI -2.06 to 5.80; p<0.0001), lower socioeconomic classes (lower-middle: OR 18.62, 95% CI -2.14 to 161.8, p=0.008; upper-lower: OR 34.27, 95% CI -3.72 to 316.0, p=0.002) and higher cost of surgery (OR 1.92, 95% CI -1.06 to 3.47, p=0.03). In the in-depth interviews, apprehensions about future matrimonial prospects of girls and lack of social support emerged as the major factors responsible for delays in undergoing surgery. Conclusions: Female gender is an important determinant of non-compliance with paediatric cardiac surgery. Deep-seated social factors underlie this gender bias.

Original languageEnglish (US)
Pages (from-to)1920-1925
Number of pages6
Issue number23
StatePublished - Dec 2011

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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