title: Influence of Ethnicity, Age, and Time on Sex Disparities in Long-Term Cause-Specific Mortality After Acute Myocardial Infarction.
abstract: We examined the influence of sex, ethnicity, and time on competing cardiovascular and noncardiovascular causes of death following acute myocardial infarction in a multiethnic Asian cohort.
  
  
  
  For 12 years, we followed a prospective nationwide cohort of 15 151 patients (aged 22-101 years, median age 63 years; 72.3% male; 66.7% Chinese, 19.8% Malay, 13.5% Indian) who were hospitalized for acute myocardial infarction between 2000 and 2005. There were 6463 deaths (4534 cardiovascular, 1929 noncardiovascular). Compared with men, women had a higher risk of cardiovascular death (age-adjusted hazard ratio [HR] 1.3, 95% CI 1.2-1.4) but a similar risk of noncardiovascular death (HR 0.9, 95% CI 0.8-1.0). Sex differences in cardiovascular death varied by ethnicity, age, and time. Compared with Chinese women, Malay women had the greatest increased hazard of cardiovascular death (HR 1.4, 95% CI 1.2-1.6) and a marked imbalance in death due to heart failure or cardiomyopathy (HR 3.4 [95% CI 1.9-6.0] versus HR 1.5 [95% CI 0.6-3.6] for Indian women). Compared with same-age Malay men, Malay women aged 22 to 49 years had a 2.5-fold (95% CI 1.6-3.8) increased hazard of cardiovascular death. Sex disparities in cardiovascular death tapered over time, least among Chinese patients and most among Indian patients; the HR comparing cardiovascular death of Indian women and men decreased from 1.9 (95% CI 1.5-2.4) at 30 days to 0.9 (95% CI 0.5-1.6) at 10 years.
  
  
  
  Age, ethnicity, and time strongly influence the association between sex and specific cardiovascular causes of mortality, suggesting that health care policy to reduce sex disparities in acute myocardial infarction outcomes must consider the complex interplay of these 3 major modifying factors.
authors: National Heart Centre Singapore, Singapore Duke-NUS Graduate Medical School, Singapore gao.fei@nhcs.com.sg.
authors: Fei
authors: F
authors: Gao
authors: National Heart Centre Singapore, Singapore Duke-NUS Graduate Medical School, Singapore.
authors: Carolyn S P
authors: CS
authors: Lam
authors: National Heart Centre Singapore, Singapore.
authors: Khung Keong
authors: KK
authors: Yeo
authors: Medical Statistics Group, School of Health and Related Research, University of Sheffield, UK Department of Cancer Studies and Molecular Medicine, Leicester Royal Infirmary, University of Leicester, UK.
authors: David
authors: D
authors: Machin
authors: National University Heart Centre Singapore, National University of Singapore, Singapore Albert Einstein Hospital, Sao Paulo, Brazil.
authors: Leonardo P
authors: LP
authors: de Carvalho
authors: National Heart Centre Singapore, Singapore.
authors: Ling Ling
authors: LL
authors: Sim
authors: National Heart Centre Singapore, Singapore.
authors: Tian Hai
authors: TH
authors: Koh
authors: Tan Tock Seng Hospital, Singapore.
authors: David
authors: D
authors: Foo
authors: Khoo Teck Puat Hospital, Singapore.
authors: Hean Yee
authors: HY
authors: Ong
authors: Changi General Hospital, Singapore.
authors: Khim Leng
authors: KL
authors: Tong
authors: National University Heart Centre Singapore, National University of Singapore, Singapore.
authors: Huay Cheem
authors: HC
authors: Tan
authors: Duke-NUS Graduate Medical School, Singapore Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
authors: Arul
authors: A
authors: Earnest
authors: National Heart Centre Singapore, Singapore.
authors: Terrance
authors: T
authors: Chua
authors: National University Heart Centre Singapore, National University of Singapore, Singapore.
authors: Mark Yan Yee
authors: MY
authors: Chan
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D044466:Asian People / Q000706:statistics & numerical data; D009202:Cardiomyopathies / Q000401:mortality; D002318:Cardiovascular Diseases / Q000401:mortality*; D002423:Cause of Death; D002681:China / Q000208:ethnology; D005006:Ethnicity / Q000706:statistics & numerical data*; D005260:Female; D054624:Health Status Disparities; D006333:Heart Failure / Q000401:mortality; D006801:Humans; D007194:India / Q000208:ethnology; D008296:Malaysia / Q000208:ethnology; D008297:Male; D008875:Middle Aged; D009026:Mortality; D009203:Myocardial Infarction; D016016:Proportional Hazards Models; D012737:Sex Factors; D012846:Singapore / Q000453:epidemiology; D013997:Time Factors; D044465:White People / Q000706:statistics & numerical data; D055815:Young Adult
keywords: acute myocardial infarction; age; ethnicity; sex disparity; time