Age-specific gender differences in early mortality following ST-segment elevation myocardial infarction in China

Xin Zheng, Rachel P Dreyer, Shuang Hu, Erica S Spatz, Frederick A Masoudi, John A Spertus, Khurram Nasir, Xi Li, Jing Li, Sisi Wang, Harlan M Krumholz, Lixin Jiang, China PEACE Collaborative Group, Xin Zheng, Rachel P Dreyer, Shuang Hu, Erica S Spatz, Frederick A Masoudi, John A Spertus, Khurram Nasir, Xi Li, Jing Li, Sisi Wang, Harlan M Krumholz, Lixin Jiang, China PEACE Collaborative Group

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).

Keywords: CORONARY ARTERY DISEASE.

Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Figures

Figure 1
Figure 1
In-hospital mortality rate following ST-segment elevation myocardial infarction among women and men by age. The interaction between gender and age was statistically significant (p=0.0007).
Figure 2
Figure 2
Unadjusted risk of in-hospital mortality comparing women with men according to age (2001, 2006 and 2011). The interaction among gender, age and year was not statistically significant (p=0.38).
Figure 3
Figure 3
Unadjusted and adjusted risk of in-hospital mortality comparing women with men by age. In the unadjusted data (left panel), the interaction between gender and age was statistically significant (p=0.0009). After adjustment for differences in patient characteristics, hospital characteristics and year of discharge (right panel), the interaction between gender and age remained statistically significant (p=0.0012).

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