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Coronary artery disease
Original article
Age-specific gender differences in early mortality following ST-segment elevation myocardial infarction in China
  1. Xin Zheng1,
  2. Rachel P Dreyer2,
  3. Shuang Hu1,
  4. Erica S Spatz2,3,
  5. Frederick A Masoudi4,5,
  6. John A Spertus6,
  7. Khurram Nasir7,
  8. Xi Li1,
  9. Jing Li1,
  10. Sisi Wang2,8,
  11. Harlan M Krumholz2,3,9,10,
  12. Lixin Jiang1,
  13. for the China PEACE Collaborative Group
  1. 1National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
  2. 2Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut, USA
  3. 3Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
  4. 4Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
  5. 5Colorado Cardiovascular Outcomes Research Consortium, Denver, Colorado, USA
  6. 6Health Outcomes Research, Saint Luke's Mid America Heart Institute/University of Missouri-Kansas City (JAS), Kansas City, Missouri, USA
  7. 7Center for Wellness & Prevention Research and Miami Cardiovascular Institute, Baptist Health South Florida, Miami, Florida, USA
  8. 8Yale School of Public Health, New Haven, Connecticut, USA
  9. 9Robert Wood Johnson Foundation Clinical Scholars Program, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
  10. 10Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut, USA
  1. Correspondence to Professor Lixin Jiang, National Clinical Research Center of Cardiovascular Diseases, Fuwai Hospital, 167 Beilishi Road, Beijing 100037, People's Republic of China; lixin.jiang{at}fwoxford.org

Abstract

Objective To assess whether younger, but not older, women in China have higher in-hospital mortality following ST-Segment Elevation Myocardial Infarction (STEMI) compared with men, and whether this relationship varied over the last decade or across rural/urban areas.

Methods We analysed a nationally representative sample of 11 986 patients with STEMI from 162 Chinese hospitals in 2001, 2006 and 2011, in the China PEACE-Retrospective AMI Study and compared in-hospital mortality between women and men with gender–age interactions in multivariable models.

Results The overall in-hospital mortality rate was higher in women compared with men (17.2% vs 9.1%, p<0.0001; unadjusted OR 2.07, 95% CI 1.85 to 2.33). The unadjusted OR for mortality in women, compared with men, was 2.20 (95% CI 1.59 to 3.04), 2.21 (95% CI 1.74 to 2.79), 1.37 (95% CI 1.15 to 1.65) and 1.25 (95% CI 0.97 to 1.63) for ages <60, 60–69, 70–79 and ≥80 years, respectively. After adjustment for patient characteristics, hospital characteristics and year of study, the OR for mortality comparing women with men was 1.69 (95% CI 1.01 to 2.83), 1.64 (95% CI 1.24 to 2.19), 1.15 (95% CI 0.90 to 1.46) and 0.82 (95% CI 0.60 to 1.11) for ages <60, 60–69, 70–79 and ≥80 years, respectively. The gender–age interaction for mortality was statistically significant (p=0.009), even after adjustment for a wide range of confounders, and did not vary over time or across rural/urban areas.

Conclusions Among a Chinese population with STEMI, gender differences in early mortality were age-dependent and greatest in the younger groups <70 years of age.

Trial registration number http://www.clinicaltrials.gov (NCT01624883).

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This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/heartjnl-2014-306456

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