Norris Colleen M, Murray Joshua W, Triplett Leona S, Hegadoren Kathleen M
University of Alberta, Edmonton, Canada.
Gend Med. 2010 Aug;7(4):330-9. doi: 10.1016/j.genm.2010.07.005.
The increased recognition of significant sex/gender differences in health status outcomes, and the implications for clinical practice and service delivery, has led to calls for more gender sensitivity and specificity in research endeavors as well as within clinical practice. Previous investigations by our research group have consistently identified important sex differences in both changes in health status from baseline to 1 year and in health status outcomes of patients treated for coronary artery disease (CAD), with women reporting poorer health-related quality of life (HRQoL) compared with men.
The objective of this study was to examine whether persistent sex differences in the health status of patients with CAD may be attributed to social factors such as gender roles.
Sex differences in baseline clinical and demographic characteristics of patients who completed the 1-year follow-up survey were examined using t tests and χ(2) analyses. Structural equation modeling, an inclusive statistical modeling approach for testing hypotheses about relationships among measured and latent variables (concepts not observed or measured directly), was used to test our theoretical model.
HRQoL data were collected on 2403 patients 1 year after index catheterization. The results indicated that the model fit was substantially improved by the addition of the conceptualized gender-role variable. Furthermore, there was a significant effect of gender role on QoL (-0.106; P < 0.05). Age, coronary anatomy, ejection fraction, physical limitation, anginal frequency, and gender role variables in this model were able to explain 51% of the variance in HRQoL. In particular, reported physical limitations, anginal frequency, and gender role had large statistically significant direct effects on HRQoL.
Advances in the treatment of CAD have led to significant decreases in mortality rates. Our current challenge is to minimize the long-term impact of CAD on HRQoL outcomes. While a substantial body of literature has examined the correlations between gender-role attributes and a wide variety of both positive and negative outcomes, this area has not been explored in patients with cardiovascular disease. These findings suggest that further study of the influence of gender role (using a gender-role measurement) on HRQoL is needed.
对健康状况结果中显著的性别差异及其对临床实践和服务提供的影响的认识不断提高，这促使人们呼吁在研究工作以及临床实践中提高性别敏感性和针对性。我们研究小组之前的调查一直发现，从基线到1年的健康状况变化以及接受冠状动脉疾病（CAD）治疗的患者的健康状况结果存在重要的性别差异，女性报告的健康相关生活质量（HRQoL）比男性差。
本研究的目的是检查CAD患者健康状况中持续存在的性别差异是否可归因于性别角色等社会因素。
使用t检验和χ²分析检查完成1年随访调查的患者基线临床和人口统计学特征的性别差异。结构方程模型是一种用于检验关于测量变量和潜在变量（未直接观察或测量的概念）之间关系的假设的包容性统计建模方法，用于检验我们的理论模型。
在首次导管插入术后1年收集了2403例患者的HRQoL数据。结果表明，添加概念化的性别角色变量后，模型拟合有显著改善。此外，性别角色对生活质量有显著影响（-0.106；P<0.05）。该模型中的年龄、冠状动脉解剖结构、射血分数、身体限制、心绞痛频率和性别角色变量能够解释HRQoL方差的51%。特别是，报告的身体限制、心绞痛频率和性别角色对HRQoL有很大的统计学显著直接影响。
CAD治疗的进展导致死亡率显著下降。我们目前面临的挑战是尽量减少CAD对HRQoL结果的长期影响。虽然大量文献研究了性别角色属性与各种积极和消极结果之间的相关性，但心血管疾病患者这一领域尚未得到探索。这些发现表明，需要进一步研究性别角色（使用性别角色测量）对HRQoL的影响。
