P0733 - Gender Difference in Interpreting Lab Values

Aaron Weiss, MD¹, Zilan Lin, MD², Nicholas Scalzo, MD³, Edward Lebovics, MD^2
1New York Medical College Westchester Medical Center, Valhalla, NY; ²Westchester Medical Center, Valhalla, NY; ³New York Medical College - Westchester Medical Center, New York, NY

Introduction: The medical literature is replete with evidence for gender disparity in certain areas of healthcare delivery, such as the treatment of chronic pain and the misdiagnosis of acute coronary syndrome. These differences are challenging to interpret as there are clinical and physiologic differences between the genders which may, in part, explain the inequity. However, the evidence of both implicit and explicit gender biases among providers suggests that true harmful biases do exist. In this study we analyzed the rate at which elevated liver tests (specifically ALT, alanine transferase) were identified as abnormal in males and females, leading to further evaluation or management. ACG guidelines define a normal ALT as 29 to 33 for males and 19 to 25 for females. An elevated ALT, even if borderline, warrants some consideration as to the cause, and monitoring for worsening.

Methods: We reviewed the charts of patients seen in teaching Internal Medicine (IM) and Gastrointestinal (GI) clinics to identify patients with elevated ALT values, subdividing the patient by recorded gender. In these clinics, patients were seen by house staff (residents and fellows) and the cases reviewed with attending physicians. We excluded any patient with a known history of liver disease. Only the first occurrence of ALT elevation was considered for each patient. For each patient, we reviewed the physicians’ notes to ascertain if they had made any comment or plan for work-up of the elevated liver test.

Results: The results are summarized in the chart and table. 1012 patients were found with ALT elevation and no known history of liver disease and were included in the study. The physician identified the elevated ALT in 23.3% of male and 15.3% of female patients. In IM clinic, elevated ALT was identified in 18.3% of males and 11.2% of females, whereas in GI clinic, it was identified in 28.5% of males and 10.1% of females. Among all patients who had ALT >33, the elevated ALT was identified in 23.5% of males and 25.5% of females.

Discussion: In both GI and IM clinics, physicians were significantly more likely to correctly identify an ALT value as abnormal in male patients. Males have a higher upper limit of normal for ALT and of note, when only looking at ALT values >33, the gender difference disappears. Thus, the disparate rates of physicians identifying elevated ALT values in males and females appears to be entirely explained by a knowledge gap in regards to the different ranges of normal ALT, rather than any other biases.


Figure: Identification of Elevated ALT as Abnormal in Male and Female Patients. Blue bar: males; Orange bar: females

	Males	Females	P-Value
Total Patients	425	587
Abnormal ALT identified	99	90
	23.29%	15.33%	0.001338
IM Clinic Patients	218	293
Abnormal ALT identified	40	33
	18.35%	11.26%	0.023578
GI Clinic Patients	207	293
Abnormal ALT identified	59	59
	28.50%	20.14%	0.030013
Total Patients with ALT >33	422	333
Abnormal ALT identified	99	85
	23.46%	25.53%	0.511521

Disclosures:
Aaron Weiss indicated no relevant financial relationships.
Zilan Lin indicated no relevant financial relationships.
Nicholas Scalzo indicated no relevant financial relationships.
Edward Lebovics indicated no relevant financial relationships.


Aaron Weiss, MD¹, Zilan Lin, MD², Nicholas Scalzo, MD³, Edward Lebovics, MD². P0733 - Gender Difference in Interpreting Lab Values, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.