Circulation, Vol 87, 1947-1953, Copyright © 1993 by American Heart Association
RJ Goldberg, EJ Gorak, J Yarzebski, DW Hosmer Jr, P Dalen, JM Gore, JS Alpert and JE Dalen
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% CI, 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% CI, 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.
ARTICLES
A communitywide 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
Department of Medicine, University of Massachusetts Medical School, Worcester 01655.
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