Sex differences in survival in patients with a hospital admission for acute myocardial infarction in Scotland 1990-2000

MacIntyre, Kate (2005) Sex differences in survival in patients with a hospital admission for acute myocardial infarction in Scotland 1990-2000. MD thesis, University of Glasgow.

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Abstract

Background Acute myocardial infarction (AMI) is an important cause of morbidity and mortality in men and women. Much of the existing literature has either focussed on men or has examined men and women together. There is a growing evidence to suggest that men and women represent distinct entities in terms of the epidemiology of AMI. This study therefore aims to examine and compare the baseline characteristics, burden of disease and survival of men and women hospitalised between 1990 and 2000 following a first and second AMI and also to determine factors that influence survival in men and women. Methods The Scottish Linked Morbidity Record Database was used to identify all patients hospitalised with a first and a second AMI between 1990 and 2000. Baseline characteristics including demographics, comorbid diagnoses and the burden of disease (including incidence, length of stay and revascularisation rates) were examined in men and women. Sex specific case fatality was calculated at a number of time points from 30 days to five years. Multivariate modelling was then used to examine factors affecting prognosis in different age groups and determine trends over time in men and women separately. Results Between 1990 and 2000, a total of 110, 226 individuals were hospitalised with a first AMI (41% women) and 9,664 individuals (40%) were hospitalised with a second AMI. Comorbid diagnoses were coded in almost half of all men and women with a first AMI and two thirds of those with a second AMI. Between 1990 and 2000, first AMI incidence declined by about one half in men and by one third in women whilst hospitalisation rates for second AMI halved. Thus, burden of disease (incidence and length of stay) fell whilst revascularisation rates increased. Unadjusted short and longer term survival was greater in men than in women. After adjusting for age and other factors women with a first AMI fared worse than men in the short term but better than men in the longer term. Short term sex differences were restricted to younger age groups. In the multivariate analyses men and women had similar short and longer term outcomes following a second AMI. Between 1990 and 2000, short term case fatality declined by approximately half in men and by one third in women over the study period. These improvements were more evident following a first AMI and in younger age groups. Conclusions Younger women hospitalised with a first AMI have high levels of comorbid disease and a worse short term prognosis than men. However women fare better than men in the longer term. Sex differences are not apparent in survival following a second AMI. This may reflect differences in treatment and in secondary prevention, and merits further research.

Item Type: Thesis (MD)
Qualification Level: Doctoral
Additional Information: Adviser: John McMurray
Keywords: Medicine
Date of Award: 2005
Depositing User: Enlighten Team
Unique ID: glathesis:2005-71873
Copyright: Copyright of this thesis is held by the author.
Date Deposited: 17 May 2019 09:31
Last Modified: 17 May 2019 09:31
URI: http://theses.gla.ac.uk/id/eprint/71873

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