Sex differences in use of interventional cardiology persist after risk adjustment
Sex differences in use of interventional cardiology persist after risk adjustment
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DOI：
10.1136/jech.2008.077537
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发表时间：
2009-03-01
影响因子：
6.3
通讯作者：
McKee, M.
中科院分区：
文献类型：
--
作者：
Nante, N.;Messina, G.;McKee, M.
背景：来自几个国家的研究记录了冠状动脉疾病管理中的性别差异。研究人员调查了意大利是否存在这种性别差异，如果存在，是否可以用年龄和疾病严重程度等因素来解释。方法：选取1999 ~ 2002年间以心肌梗死（ICD 410）、心绞痛（ICD 413）、慢性缺血（ICD 414）、胸痛（ICD 786.5）为首发诊断的皮埃蒙特患者77974例。提取接受手术治疗的男性和女性人数，并计算男女优势比。几个危险因素和风险调整技术（APR-DRG）被用来控制可能的混杂因素。采用反向逐步多元逻辑回归对显著协变量进行校正。结果：粗略分析显示，性别是手术概率的一个判别因素（OR 2.11, 95% CI 2.04 ~ 2.19），各主要诊断的结果相似。校正年龄、合并症和疾病严重程度后，优势比下降，但仍然显著。结论：在意大利北部的一个地区，被诊断为心血管疾病的男性和女性在医院接受的治疗不同，这不能用年龄或疾病的严重程度来解释。
Background: Studies from several countries have documented gender disparities in the management of coronary artery disease. Whether such gender disparities are seen in Italy and, if so, whether they can be explained by factors such as age and severity of illness were investigated.Methods: 77 974 Piedmontese patients, admitted between 1999 and 2002, with a primary diagnosis of myocardial infarction (ICD 410), angina (ICD 413), chronic ischaemia (ICD 414) and chest pain (ICD 786.5) were studied. The number of men and women undergoing surgical treatment was extracted and the male-female odds ratios calculated. Several risk factors and a risk adjustment technique (APR-DRG) were used to control for possible confounders. Backward stepwise multiple logistic regression was used to adjust for significant covariates.Results: Crude analysis demonstrated that gender is a discriminating factor in the probability of surgery (OR 2.11, 95% CI 2.04 to 2.19), with similar findings among those with each main diagnosis. The odds ratios decreased after adjustment for age, co-morbidity and disease severity but remained significant.Conclusions: Men and women admitted to hospitals in a region of northern Italy with a diagnosis of cardiovascular disease are treated differently and this cannot be explained by age or severity of disease.