A COMMUNITY-WIDE PERSPECTIVE OF SEX-DIFFERENCES AND TEMPORAL TRENDS IN THE INCIDENCE AND SURVIVAL RATES AFTER ACUTE MYOCARDIAL-INFARCTION AND OUT-OF-HOSPITAL DEATHS CAUSED BY CORONARY HEART-DISEASE
A COMMUNITY-WIDE PERSPECTIVE OF SEX-DIFFERENCES AND TEMPORAL TRENDS IN THE INCIDENCE AND SURVIVAL RATES AFTER ACUTE MYOCARDIAL-INFARCTION AND OUT-OF-HOSPITAL DEATHS CAUSED BY CORONARY HEART-DISEASE
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DOI：
10.1161/01.cir.87.6.1947
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发表时间：
1993-06-01
期刊：
影响因子：
37.8
通讯作者：
DALEN, JE
中科院分区：
文献类型：
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作者：
GOLDBERG, RJ;GORAK, EJ;DALEN, JE
背景。本研究旨在探讨男性和女性在初次急性心肌梗死（AMI）的发病率、住院期间和长期生存率以及冠心病导致的院外死亡方面的总体差异及其时间趋势。
方法与结果。这项非同期前瞻性研究于1975年至1988年间的6个时间段在马萨诸塞州伍斯特市的16家教学医院和社区医院进行。共有3148名经确诊为初次AMI的住院患者构成研究样本。1975年至1981年间，两性初次AMI的年龄调整发病率均上升，此后显著下降，1975年至1988年间男性发病率下降了26%，女性下降了22%。初次AMI后总体未经调整的住院病死率女性（21.7%）显著高于男性（12.7%）。然而，年龄和多变量调整后的住院病死率男性与女性相比无显著差异（多变量调整后的比值比为0.90；95%置信区间为0.70 - 1.16）。在研究期间，男性或女性的住院病死率均未观察到明显趋势。在AMI出院幸存者的年龄调整长期生存率方面，性别间无显著差异。然而，男性出院幸存者的多变量调整后的总死亡风险显著增加（多变量调整后的比值比为1.20；95%置信区间为1.03 - 1.39）；两性的长期预后均未随时间改善。1975年至1988年间，冠心病导致的院外死亡发病率男性下降了60%，女性下降了69%。
结论。这项基于多医院和社区的研究结果表明，在研究期间（1975 - 1988年），男性和女性的AMI发病率以及冠心病导致的院外死亡发病率均下降。住院生存率方面未观察到显著性别差异，而在控制了潜在的混杂预后因素后，男性出院后的长期生存情况较女性差。
Background. The purpose of the study was to examine overall differences and temporal trends therein between men and women regarding the incidence rates, in-hospital and long-term survival after initial acute myocardial infarction (AMI), and out-of-hospital deaths caused by coronary disease.Methods and Results. This nonconcurrent prospective study was carried out in 16 teaching and community hospitals in Worcester, Mass., in six time periods between 1975 and 1988. A total of 3,148 patients hospitalized with validated initial AMI comprised the study sample. The age-adjusted incidence rates of initial AMI increased between 1975 and 1981 in the two sexes, with a marked decrease thereafter, these rates declined by 26% in men and by 22% in women between 1975 and 1988. The overall unadjusted in-hospital case-fatality rates after initial AMI were significantly higher in women (21.7%) than in men (12.7%). Age- and multivariable-adjusted in-hospital case-fatality rates, however, were not significantly different for men compared with women (multivariate-adjusted OR, 0.90; 95% Cl, 0.70, 1.16). No clear trends in in-hospital case-fatality rates were observed in men or women over the periods under study. There were no significant sex differences in the age-adjusted long-term survival rates of discharged hospital survivors of AMI. The multivariate-adjusted risk of total mortality among discharged hospital survivors, however, was significantly increased in men (multivariate-adjusted OR, 1.20; 95% Cl, 1.03, 1.39); neither of the sexes experienced an improvement over time in long-term prognosis. The incidence rates of out-of-hospital deaths caused by coronary disease declined by 60% in men and 69% in women between 1975 and 1988.Conclusions. The results of this multihospital, community-based study suggest declines in the incidence rates of AMI and out-of-hospital deaths caused by coronary disease in men and women over the period under study (1975-1988). No significant sex differences in in-hospital survival were observed, whereas a poorer long-term survival experience after hospital discharge was observed for men compared with women after controlling for potentially confounding prognostic factors.