Sex differences in 2-year mortality after hospital discharge for myocardial infarction.
BACKGROUND
An interaction between sex and age is thought to affect hospital mortality after myocardial infarction; younger, but not older, women have been shown to have higher mortality rates than men. It is currently unknown whether findings are similar after hospital discharge.


OBJECTIVE
To determine whether an interaction between sex and age affects 2-year mortality after myocardial infarction.


METHODS
Community-based prospective cohort study.


METHODS
16 community hospitals serving the Worcester, Massachusetts, metropolitan area.


METHODS
6826 patients who survived hospitalization for acute myocardial infarction during ten 1-year periods between 1975 and 1995.


METHODS
Mortality 2 years after hospital discharge.


RESULTS
The overall 2-year mortality rate was higher in women (28.9%) than in men (19.6%). When patients were examined by age group, however, only women younger than 60 years of age had a higher mortality rate than men of similar age. The sex difference decreased with increasing age; among the oldest patients, women had a lower mortality rate than men (P = 0.009 for the interaction between sex and age). This relationship was not affected by adjustment for demographic characteristics and medical history, clinical characteristics, and hospital and discharge treatments; the hazard of 2-year death for women compared with men increased 15.4% (95% CI, 4.3% to 27.6%) for every 10-year decrease in age. In absolute terms, after adjustment for demographic characteristics and medical history, among patients younger than 60 years of age women were at greater risk than men (risk difference, 1.8 percentage points). At older ages, however, women were at lower risk than men.


CONCLUSIONS
Younger, but not older, women who survive hospitalization for myocardial infarction have a higher long-term mortality rate than men. This provides additional evidence that younger women with myocardial infarction are at greater risk for death than men.
Vaccarino
V
V
Department of Medicine (Cardiology), Emory University School of Medicine, Emory West, 1256 Briarcliff Road, Suite 1 North, Atlanta, GA 30306, USA.
Krumholz
H M
HM
Yarzebski
J
J
Gore
J M
JM
Goldberg
R J
RJ
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016015:Logistic Models; D008297:Male; D008404:Massachusetts / Q000453:epidemiology; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality*; D010351:Patient Discharge; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012737:Sex Factors