Impact of diabetes and gender on survival after acute myocardial infarction in the Province of Quebec, Canada--a population-based study.
OBJECTIVE
To examine the impact of diabetes, gender and their interaction on 30-day, 1-year and 5-year post-acute myocardial infarction (AMI) mortality in three age groups (20-64, 65-74 and > or = 75 years).


METHODS
Retrospective analysis including 23 700 patients aged > or = 20 years (22% with diabetes) admitted to hospital for a first AMI in any hospital in the Province of Quebec, Canada, between April 1995 and March 1997. Administrative databases were used to identify patients and assess outcomes.


RESULTS
Regarding 30-day mortality, there was non-significant interaction between diabetes and gender. Women aged < 75 years had, independently of diabetes status, at least a 38% (P < 0.05) higher mortality than their male counterparts after adjustment for socio-economic status and co-morbid conditions. Gender difference disappeared, however, after controlling for in-hospital complications. Regarding 1-year mortality (31-365 days), there was no significant gender disparity for all age groups. During the 5-year follow-up, no gender differences were seen in any age group, except for younger (< 65 years) women with diabetes, who had a 52% (P = 0.004) higher mortality than men after controlling for co-variables. This female disadvantage was demonstrated by a significant interaction between diabetes and gender in patients aged < 65 years (P = 0.009).


CONCLUSIONS
The higher 30-day mortality post-AMI in younger (20-64 years) and middle-aged (65-74 years) women compared with men was not influenced by diabetes status. However, during the 5-year follow-up, the similar gender mortality observed in patients without diabetes seemed to disappear in younger patients with diabetes, which may be explained by the deleterious, long-term, post-AMI impact of diabetes in younger women.
Ouhoummane
N
N
National Public Health Institute of Quebec, Québec, QC, Canada.
Abdous
B
B
Emond
V
V
Poirier
P
P
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003920:Diabetes Mellitus / Q000453:epidemiology / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology / Q000401:mortality*; D011792:Quebec; D012189:Retrospective Studies; D012737:Sex Factors; D055815:Young Adult