Influence of Ethnicity, Age, and Time on Sex Disparities in Long-Term Cause-Specific Mortality After Acute Myocardial Infarction.
| Title: | Influence of Ethnicity, Age, and Time on Sex Disparities in Long-Term Cause-Specific Mortality After Acute Myocardial Infarction. |
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| Authors: | Gao F; National Heart Centre Singapore, Singapore Duke-NUS Graduate Medical School, Singapore gao.fei@nhcs.com.sg.; Lam CS; National Heart Centre Singapore, Singapore Duke-NUS Graduate Medical School, Singapore.; Yeo KK; National Heart Centre Singapore, Singapore.; Machin D; Medical Statistics Group, School of Health and Related Research, University of Sheffield, UK Department of Cancer Studies and Molecular Medicine, Leicester Royal Infirmary, University of Leicester, UK.; de Carvalho LP; National University Heart Centre Singapore, National University of Singapore, Singapore Albert Einstein Hospital, Sao Paulo, Brazil.; Sim LL; National Heart Centre Singapore, Singapore.; Koh TH; National Heart Centre Singapore, Singapore.; Foo D; Tan Tock Seng Hospital, Singapore.; Ong HY; Khoo Teck Puat Hospital, Singapore.; Tong KL; Changi General Hospital, Singapore.; Tan HC; National University Heart Centre Singapore, National University of Singapore, Singapore.; Earnest A; Duke-NUS Graduate Medical School, Singapore Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.; Chua T; National Heart Centre Singapore, Singapore.; Chan MY; National University Heart Centre Singapore, National University of Singapore, Singapore. |
| Source: | Journal of the American Heart Association [J Am Heart Assoc] 2016 Oct 06; Vol. 5 (10). Date of Electronic Publication: 2016 Oct 06. |
| Publication Type: | Journal Article |
| Language: | English |
| Journal Info: | Publisher: Wiley-Blackwell Country of Publication: England NLM ID: 101580524 Publication Model: Electronic Cited Medium: Internet ISSN: 2047-9980 (Electronic) Linking ISSN: 20479980 NLM ISO Abbreviation: J Am Heart Assoc Subsets: MEDLINE |
| Imprint Name(s): | Original Publication: Oxford : Wiley-Blackwell |
| MeSH Terms: | Health Status Disparities* ; Myocardial Infarction*; Cardiovascular Diseases/*mortality ; Ethnicity/*statistics & numerical data; Asian People/statistics & numerical data ; Cardiomyopathies/mortality ; China/ethnology ; Heart Failure/mortality ; India/ethnology ; Malaysia/ethnology ; Singapore/epidemiology ; White People/statistics & numerical data ; Adult ; Age Factors ; Aged ; Aged, 80 and over ; Cause of Death ; Female ; Humans ; Male ; Middle Aged ; Mortality ; Proportional Hazards Models ; Sex Factors ; Time Factors ; Young Adult |
| Abstract: | Background: We examined the influence of sex, ethnicity, and time on competing cardiovascular and noncardiovascular causes of death following acute myocardial infarction in a multiethnic Asian cohort.; Methods and Results: For 12 years, we followed a prospective nationwide cohort of 15 151 patients (aged 22-101 years, median age 63 years; 72.3% male; 66.7% Chinese, 19.8% Malay, 13.5% Indian) who were hospitalized for acute myocardial infarction between 2000 and 2005. There were 6463 deaths (4534 cardiovascular, 1929 noncardiovascular). Compared with men, women had a higher risk of cardiovascular death (age-adjusted hazard ratio [HR] 1.3, 95% CI 1.2-1.4) but a similar risk of noncardiovascular death (HR 0.9, 95% CI 0.8-1.0). Sex differences in cardiovascular death varied by ethnicity, age, and time. Compared with Chinese women, Malay women had the greatest increased hazard of cardiovascular death (HR 1.4, 95% CI 1.2-1.6) and a marked imbalance in death due to heart failure or cardiomyopathy (HR 3.4 [95% CI 1.9-6.0] versus HR 1.5 [95% CI 0.6-3.6] for Indian women). Compared with same-age Malay men, Malay women aged 22 to 49 years had a 2.5-fold (95% CI 1.6-3.8) increased hazard of cardiovascular death. Sex disparities in cardiovascular death tapered over time, least among Chinese patients and most among Indian patients; the HR comparing cardiovascular death of Indian women and men decreased from 1.9 (95% CI 1.5-2.4) at 30 days to 0.9 (95% CI 0.5-1.6) at 10 years.; Conclusion: Age, ethnicity, and time strongly influence the association between sex and specific cardiovascular causes of mortality, suggesting that health care policy to reduce sex disparities in acute myocardial infarction outcomes must consider the complex interplay of these 3 major modifying factors.; (© 2016 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.) |
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| Contributed Indexing: | Keywords: acute myocardial infarction; age; ethnicity; sex disparity; time |
| Entry Date(s): | Date Created: 20161030 Date Completed: 20171219 Latest Revision: 20221207 |
| Update Code: | 20260130 |
| PubMed Central ID: | PMC5121478 |
| DOI: | 10.1161/JAHA.116.003760 |
| PMID: | 27792637 |
| Database: | MEDLINE |
Journal Article