title: Life Expectancy and Years of Potential Life Lost After Acute Myocardial Infarction by Sex and Race: A Cohort-Based Study of Medicare Beneficiaries.
abstract: BACKGROUND
  Most studies of sex and race differences after acute myocardial infarction (AMI) have not taken into account differences in life expectancy in the general population. Years of potential life lost (YPLL) is a metric that takes into account the burden of disease and can be compared by sex and race.
  
  
  OBJECTIVE
  This study sought to determine sex and race differences in long-term survival after AMI using life expectancy and YPLL to account for differences in population-based life expectancy.
  
  
  METHODS
  Using data from the Cooperative Cardiovascular Project, a prospective cohort study of Medicare beneficiaries hospitalized for AMI between 1994 and 1995 (N = 146,743), we calculated life expectancy and YPLL using Cox proportional hazards regression with extrapolation using exponential models.
  
  
  RESULTS
  Of the 146,743 patients with AMI, 48.1% were women and 6.4% were black; the average age was 75.9 years. Post-AMI life expectancy estimates were similar for men and women of the same race but lower for black patients than white patients. On average, women lost 10.5% (SE 0.3%) more of their expected life than men, and black patients lost 6.2% (SE 0.6%) more of their expected life than white patients. After adjustment, women still lost an average of 7.8% (0.3%) more of their expected life than men, but black race became associated with a survival advantage, suggesting that racial differences in YPLL were largely explained by differences in clinical presentation and treatment between black and white patients.
  
  
  CONCLUSIONS
  Women and black patients lost more years of life after AMI, on average, than men and white patients, an effect that was not explained in women by clinical or treatment differences.
authors.affiliation: Yale School of Medicine and Yale School of Public Health, New Haven, Connecticut.
authors.forename: Emily M
authors.initials: EM
authors.lastname: Bucholz
authors.affiliation: Department of Health Care Policy, Harvard Medical School and Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
authors.forename: Sharon-Lise T
authors.initials: SL
authors.lastname: Normand
authors.affiliation: Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut.
authors.forename: Yun
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut.
authors.forename: Shuangge
authors.initials: S
authors.lastname: Ma
authors.affiliation: Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut.
authors.forename: Haiqun
authors.initials: H
authors.lastname: Lin
authors.affiliation: Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut; Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut; Robert Wood Johnson Foundation Clinical Scholars Program, Yale University School of Medicine, New Haven, Connecticut; Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut. Electronic address: harlan.krumholz@yale.edu.
authors.forename: Harlan M
authors.initials: HM
authors.lastname: Krumholz
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D044383:Black People / Q000208:ethnology*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008017:Life Expectancy / Q000639:trends*; D008297:Male; D006278:Medicare / Q000639:trends*; D009203:Myocardial Infarction / Q000175:diagnosis / Q000208:ethnology* / Q000401:mortality; D011446:Prospective Studies; D044469:Racial Groups / Q000208:ethnology; D012727:Sex Characteristics; D014481:United States / Q000208:ethnology; D044465:White People / Q000208:ethnology*; D001741:Black or African American
keywords: acute coronary syndromes; population perspective; survival