Gender differences in the relationship between diabetes process of care indicators and cardiovascular outcomes.
BACKGROUND
Adherence to recommended guidelines in the care for diabetes has been demonstrated to significantly prevent the excess risk of hospitalization and mortality for cardiovascular diseases. Aim of this study was to evaluate whether adherence to a standardized process quality-of-care-indicator in diabetes, is able to predict, equally in men and women, first hospitalization or mortality risk after acute myocardial infarction (AMI), ischemic stroke (IS), congestive heart failure (CHF), lower extremity amputations (LEA) or any of above major adverse cardiovascular events (MACE).


METHODS
Guideline composite indicator (GCI), a process indicator including one annual assessment of HbA1c and at least two among eye examination, serum lipids measurement and microalbuminuria, was measured in the year 2006 in 91 826 (46 167 M/45 659 F) diabetic patients, living in Tuscany (Italy). By a Cox-proportional hazard regression model, the effect of GCI adherence was assessed on adjusted hospitalization mortality risk for AMI, IS, CHF, LEA and MACE in both genders in a follow-up period of 6 years (2007-12).


RESULTS
After adjusting for covariates, adherence to CGI exerted a significant positive effect on AMI, CHF and LEA outcomes among men, whereas among women, GCI adherence significantly decreased hospitalization risk only for CHF and mortality risk after IS. Finally, GCI adherence significantly reduced hospitalization risk for MACE of about 15% and 11% in men and women, respectively. On the contrary, GCI adherence seemed to have no significant influence on mortality risk after hospitalization for MACE in both genders.


CONCLUSIONS
In this cohort, over a 6-year follow-up, GCI adherence was found to be a significant predictor of lower cardiovascular risk, with some evident gender differences.
1 Laboratorio Management e Sanità, Istituto di Management, Scuola Superiore Sant'Anna, Pisa, Italy.
Chiara
C
Seghieri
2 Agenzia Regionale Sanità, Regione Toscana, Florence, Italy.
Laura
L
Policardo
2 Agenzia Regionale Sanità, Regione Toscana, Florence, Italy.
Paolo
P
Francesconi
2 Agenzia Regionale Sanità, Regione Toscana, Florence, Italy 3 Centre of Study for Gender Health, Azienda USL 3, Pistoia, Italy gseghier@tin.it.
Giuseppe
G
Seghieri
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000419:Albuminuria / Q000175:diagnosis; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000401:mortality*; D003920:Diabetes Mellitus / Q000453:epidemiology / Q000628:therapy*; D005260:Female; D006442:Glycated Hemoglobin; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007558:Italy; D008055:Lipids / Q000097:blood; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D016016:Proportional Hazards Models; D019984:Quality Indicators, Health Care; D012307:Risk Factors; D012737:Sex Factors; D013997:Time Factors; D014787:Vision Tests; D055815:Young Adult
D006442:Glycated Hemoglobin; D008055:Lipids