Young Hispanic Women Experience Higher In-Hospital Mortality Following an Acute Myocardial Infarction.
Young Hispanic Women Experience Higher In-Hospital Mortality Following an Acute Myocardial Infarction.
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DOI：
10.1161/jaha.115.002089
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发表时间：
2015-09-09
影响因子：
5.4
通讯作者：
López L
中科院分区：
文献类型：
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作者：
Rodriguez F;Foody JM;Wang Y;López L
尽管男性和女性的急性心肌梗死 (AMI) 死亡率有所下降，但之前的研究报告称，死亡率存在性别差距，因此年轻女性最有可能在 AMI 后死亡。我们试图探讨种族和族裔对当代患者队列中年轻女性 AMI 护理模式和死亡率性别差距的影响。我们构建了多变量分层逻辑回归模型，以按性别、年龄（<65 岁和≥65 岁）和种族/族裔（白人、黑人和西班牙裔）检查 AMI 住院、手术和院内死亡率的趋势。分析源自 194 071 名因 AMI 住院的患者，其中包含 2009-2010 年全国住院患者样本中的可用种族和民族数据。对不同年龄、性别和种族/民族的住院率、手术（冠状动脉造影、经皮冠状动脉介入治疗和心脏搭桥手术）和住院患者死亡率进行了分析。不同年龄和种族/族裔的住院率存在显着差异。与白人相比，所有种族/族裔群体接受侵入性手术的可能性较小（P<0.001）。调整合并症后，与年轻白人男性相比，年轻的西班牙裔女性的院内死亡率更高，根据年龄和合并症进行调整后，比值比为 1.5（95% CI 1.2 至 1.9）。我们发现 AMI 住院治疗、护理模式和死亡率存在显着的种族和性别差异，年轻的西班牙裔女性的住院死亡率更高。未来的研究有必要探索 AMI 结果中这些显着种族和性别差异的决定因素。
Although mortality rates for acute myocardial infarction (AMI) have declined for men and women, prior studies have reported a sex gap in mortality such that younger women were most likely to die after an AMI. We sought to explore the impact of race and ethnicity on the sex gap in AMI patterns of care and mortality for younger women in a contemporary patient cohort. We constructed multivariable hierarchical logistic regression models to examine trends in AMI hospitalizations, procedures, and in-hospital mortality by sex, age (<65 and ≥65 years), and race/ethnicity (white, black, and Hispanic). Analyses were derived from 194 071 patients who were hospitalized for an AMI with available race and ethnicity data from the 2009–2010 National Inpatient Sample. Hospitalization rates, procedures (coronary angiography, percutaneous coronary interventions, and cardiac bypass surgery), and inpatient mortality were analyzed across age, sex, and race/ethnic groups. There was significant variation in hospitalization rates by age and race/ethnicity. All racial/ethnic groups were less likely to undergo invasive procedures compared with white men (P<0.001). After adjustment for comorbidities, younger Hispanic women experienced higher in-hospital mortality compared with younger white men, with an odds ratio of 1.5 (95% CI 1.2 to 1.9), adjusted for age and comorbidities. We found significant racial and sex disparities in AMI hospitalizations, care patterns, and mortality, with higher in-hospital mortality experienced by younger Hispanic women. Future studies are necessary to explore determinants of these significant racial and sex disparities in outcomes for AMI.