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Influence of Ethnicity, Age, and Time on Sex Disparities in Long ‐ Term Cause ‐ Specific Mortality After Acute Myocardial Infarction

View Article: PubMed Central - PubMed

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.

No MeSH data available.


Related in: MedlinePlus

Competing cumulative incidences of cardiovascular and noncardiovascular death after acute myocardial infarction in men and women of Chinese, Malay, and Indian ethnicity.
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jah31798-fig-0001: Competing cumulative incidences of cardiovascular and noncardiovascular death after acute myocardial infarction in men and women of Chinese, Malay, and Indian ethnicity.

Mentions: At 10 years, the all‐cause mortality rates were 37.5% and 62.9% for men and women, respectively, and 44.7%, 48.9%, and 37.8% for Chinese, Malay, and Indian patients, respectively. For cardiovascular mortality, the 10‐year rates were 23.2% for Chinese men, 43.3% for Chinese women; 29.3% for Malay men, 51.2% for Malay women, 24.3% for Indian men, and 35.3% for Indian women (Figure 1). For noncardiovascular mortality, the 10‐year rates were 12.5% for Chinese men, 17.6% for Chinese women, 9.9% for Malay men, 14.3% for Malay women, 7.8% for Indian men, and 13.4% for Indian women (Figure 1). In all sex–ethnicity groups, the risk of cardiovascular death was greater than the risk of noncardiovascular death, with HRs of cardiovascular versus noncardiovascular death ranging from 1.9 for Chinese men to 3.6 for Malay women (Table 2).


Influence of Ethnicity, Age, and Time on Sex Disparities in Long ‐ Term Cause ‐ Specific Mortality After Acute Myocardial Infarction
Competing cumulative incidences of cardiovascular and noncardiovascular death after acute myocardial infarction in men and women of Chinese, Malay, and Indian ethnicity.
© Copyright Policy - creativeCommonsBy-nc
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5121478&req=5

jah31798-fig-0001: Competing cumulative incidences of cardiovascular and noncardiovascular death after acute myocardial infarction in men and women of Chinese, Malay, and Indian ethnicity.
Mentions: At 10 years, the all‐cause mortality rates were 37.5% and 62.9% for men and women, respectively, and 44.7%, 48.9%, and 37.8% for Chinese, Malay, and Indian patients, respectively. For cardiovascular mortality, the 10‐year rates were 23.2% for Chinese men, 43.3% for Chinese women; 29.3% for Malay men, 51.2% for Malay women, 24.3% for Indian men, and 35.3% for Indian women (Figure 1). For noncardiovascular mortality, the 10‐year rates were 12.5% for Chinese men, 17.6% for Chinese women, 9.9% for Malay men, 14.3% for Malay women, 7.8% for Indian men, and 13.4% for Indian women (Figure 1). In all sex–ethnicity groups, the risk of cardiovascular death was greater than the risk of noncardiovascular death, with HRs of cardiovascular versus noncardiovascular death ranging from 1.9 for Chinese men to 3.6 for Malay women (Table 2).

View Article: PubMed Central - PubMed

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.

No MeSH data available.


Related in: MedlinePlus