title: Sex Differences in Clinical Profiles and Quality of Care Among Patients With ST-Segment Elevation Myocardial Infarction From 2001 to 2011: Insights From the China Patient-Centered Evaluative Assessment of Cardiac Events (PEACE)-Retrospective Study.
abstract: BACKGROUND
  China is experiencing a marked increase in ST-segment elevation myocardial infarction hospitalizations, with 30% occurring among women and higher risk of in-hospital death in relatively younger age groups (<70). Yet, little is known about sex differences in ST-segment elevation myocardial infarction presentation and management.
  
  
  RESULTS
  In a nationally representative sample of patients with ST-segment elevation myocardial infarction admitted to 162 Chinese hospitals in 2001, 2006, and 2011, we examined sex differences in hospitalization rates, clinical profiles, and quality of care. Among 11 986 patients, the proportion of women was unchanged between 2001 and 2011. The estimated national rates of hospital admission per 100 000 people increased from 4.6 in 2001 to 18.0 in 2011 among men (3.9-fold increase) and from 1.9 to 8.0 among women (4.2-fold increase) (Ptrend<0.0001). The median age of women increased from 68 years in 2001 to 72 years in 2011 (Ptrend<0.001); however, there was no age change in men (63 years in 2011) (Ptrend=0.48). After accounting for age, women had a higher frequency of comorbidities. Although there were significant sex differences in the time interval of >12 hours between symptom onset and admission time in 2001, since 2006 delays in presentation were comparable between women and men. Fewer women without contraindications received evidence-based therapies than men, including reperfusion (57.5% versus 44.2%), early aspirin (88.8% versus 85.9%), and clopidogrel (56.9% versus 52.5%, P<0.001 for all) and the differences were largely unchanged over time.
  
  
  CONCLUSIONS
  Women experienced a higher increase in hospitalization rates for ST-segment elevation myocardial infarction in China between 2001 and 2011 and were less likely to receive evidence-based therapies, especially reperfusion. In addition to efforts to improve quality of care generally, understanding the reasons for this sex disparity and addressing these differences in care should be a priority.
  
  
  BACKGROUND
  URL: https://www.clinicaltrials.gov. Unique identifier: NCT01624883.
authors.affiliation: National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
authors.forename: Xue
authors.initials: X
authors.lastname: Du
authors.affiliation: Center for Outcomes Research and Evaluation (CORE), Yale-New Haven Hospital, New Haven, CT Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT Department of Internal Medicine, Yale School of Medicine, New Haven, CT.
authors.forename: Erica S
authors.initials: ES
authors.lastname: Spatz
authors.affiliation: Center for Outcomes Research and Evaluation (CORE), Yale-New Haven Hospital, New Haven, CT Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT.
authors.forename: Rachel P
authors.initials: RP
authors.lastname: Dreyer
authors.affiliation: National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
authors.forename: Shuang
authors.initials: S
authors.lastname: Hu
authors.affiliation: National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
authors.forename: Chaoqun
authors.initials: C
authors.lastname: Wu
authors.affiliation: National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
authors.forename: Xi
authors.initials: X
authors.lastname: Li
authors.affiliation: National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
authors.forename: Jing
authors.initials: J
authors.lastname: Li
authors.affiliation: Center for Outcomes Research and Evaluation (CORE), Yale-New Haven Hospital, New Haven, CT.
authors.forename: Sisi
authors.initials: S
authors.lastname: Wang
authors.affiliation: Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, CO Colorado Cardiovascular Outcomes Research Consortium, Denver, CO.
authors.forename: Frederick A
authors.initials: FA
authors.lastname: Masoudi
authors.affiliation: University of Missouri-Kansas City, School of Medicine, Biomedical & Health Informatics, Kansas City, MO Saint Luke's Mid America Heart Institute, Kansas City, MO.
authors.forename: John A
authors.initials: JA
authors.lastname: Spertus
authors.affiliation: Center for Healthcare Advancement & Outcomes, Baptist Health South Florida, Miami, FL Miami Cardiac & Vascular Institute, Baptist Health South Florida, Miami, FL.
authors.forename: Khurram
authors.initials: K
authors.lastname: Nasir
authors.affiliation: Center for Outcomes Research and Evaluation (CORE), Yale-New Haven Hospital, New Haven, CT Department of Internal Medicine, Yale School of Medicine, New Haven, CT Section of Cardiovascular Medicine, Robert Wood Johnson Clinical Scholars Program, Department of Health Policy and Management, Yale School of Public Health, New Haven, CT.
authors.forename: Harlan M
authors.initials: HM
authors.lastname: Krumholz
authors.affiliation: National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China jiangl@fwoxford.org.
authors.forename: Lixin
authors.initials: L
authors.lastname: Jiang
mesh_terms: D000367:Age Factors; D000368:Aged; D002317:Cardiovascular Agents / Q000627:therapeutic use*; D002681:China; D015897:Comorbidity; D005260:Female; D054624:Health Status Disparities; D054625:Healthcare Disparities / Q000639:trends*; D017052:Hospital Mortality; D006760:Hospitalization / Q000639:trends*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D015425:Myocardial Reperfusion / Q000639:trends*; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D002317:Cardiovascular Agents
keywords: acute myocardial infarction; epidemiology; health policy; quality of care; sex