Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
CMAJ. 2011 Sep 20;183(13):1482-91. doi: 10.1503/cmaj.110170. Epub 2011 Jul 18.
Coronary artery disease is the most common cause of death in the Western world, and being married decreases the risk of death from cardiovascular causes. We aimed to determine whether marital status was a predictor of the duration of chest pain endured by patients with acute myocardial infarction before they sought care and whether the patient's sex modified the effect.
We conducted a retrospective, population-based cohort analysis of patients with acute myocardial infarction admitted to 96 acute care hospitals in Ontario, Canada, from April 2004 to March 2005. We excluded patients who did not experience chest pain. Using multivariable regression analyses, we assessed marital status in relation to delayed presentation to hospital (more than six hours from onset of pain), both overall and stratified by sex. In patients who reported the exact duration of chest pain, we assessed the effect of marital status on the delay in seeking care.
Among 4403 eligible patients with acute myocardial infarction, the mean age was 67.3 (standard deviation 13.6) years, and 1486 (33.7%) were women. Almost half (2037 or 46.3%) presented to a hospital within two hours, and 3240 (73.6%) presented within six hours. Overall, 75.3% (2317/3079) of married patients, 67.9% (188/277) of single patients, 68.5% (189/276) of divorced patients and 70.8% (546/771) of widowed patients presented within six hours of the onset of chest pain. Being married was associated with lower odds of delayed presentation (odds ratio [OR] 0.46, 95% confidence interval [CI] 0.30-0.71, p < 0.001) relative to being single. Among men, the OR was 0.35 (95% CI 0.21-0.59, p < 0.001), whereas among women the effect of marital status was not significant (OR 1.36, 95% CI 0.49-3.73, p = 0.55).
Among men experiencing acute myocardial infarction with chest pain, being married was associated with significantly earlier presentation for care, a benefit that was not observed for married women. Earlier presentation for medical care appears to be one reason for the observed lower risk of cardiovascular death among married men, relative to their single counterparts.
冠心病是西方世界最常见的死亡原因，而已婚会降低心血管疾病导致的死亡风险。我们旨在确定婚姻状况是否可预测急性心肌梗死患者胸痛发作后寻求医疗的时间长短，以及患者的性别是否会改变这种影响。
我们对 2004 年 4 月至 2005 年 3 月期间在加拿大安大略省 96 家急性护理医院就诊的急性心肌梗死患者进行了回顾性基于人群的队列分析。我们排除了没有胸痛的患者。我们使用多变量回归分析评估了婚姻状况与延迟就诊（疼痛发作后超过 6 小时）之间的关系，既包括整体情况，也包括按性别分层的情况。对于报告胸痛确切持续时间的患者，我们评估了婚姻状况对寻求医疗时间的影响。
在 4403 名符合条件的急性心肌梗死患者中，平均年龄为 67.3（标准差 13.6）岁，其中 1486 名（33.7%）为女性。近一半（2037 名，46.3%）在 2 小时内就诊，3240 名（73.6%）在 6 小时内就诊。总体而言，75.3%（2317/3079）的已婚患者、67.9%（188/277）的单身患者、68.5%（189/276）的离婚患者和 70.8%（546/771）的丧偶患者在胸痛发作后 6 小时内就诊。与单身患者相比，已婚患者的就诊延迟几率较低（比值比 [OR] 0.46，95%置信区间 [CI] 0.30-0.71，p<0.001）。在男性中，OR 为 0.35（95%CI 0.21-0.59，p<0.001），而在女性中，婚姻状况的影响不显著（OR 1.36，95%CI 0.49-3.73，p=0.55）。
在经历胸痛的急性心肌梗死男性患者中，已婚与更早的医疗就诊相关，而这种益处并未在已婚女性中观察到。更早地寻求医疗护理似乎是已婚男性相对于单身男性心血管死亡风险较低的一个原因。
