Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena (M.T.M., B.H.L., L.Q., S.R.R., T.N.H., S.J.J., K.R.).
Center for Observational Research, Amgen, Inc, Thousand Oaks, CA (S.R.R.).
Circulation. 2020 Feb 18;141(7):509-519. doi: 10.1161/CIRCULATIONAHA.119.044738. Epub 2020 Feb 17.
In recent decades, the rates of incident acute myocardial infarction (AMI) have declined in the United States, yet disparities by sex remain. In an integrated healthcare delivery system, we examined temporal trends in incident AMI among women and men.
We identified hospitalized AMI among members ≥35 years of age in Kaiser Permanente Southern California. The first hospitalization for AMI overall, and for ST-segment-elevation MI and non-ST-segment-elevation MI was identified by primary discharge diagnosis codes in each calendar year from 2000 through 2014. Age- and sex-standardized incidence rates per 100 000 person-years were calculated by using direct adjustment to the 2010 US Census population. Average annual percent changes (AAPCs) and period percent changes were calculated, and trend tests were conducted using Poisson regression.
We identified 45 331 AMI hospitalizations between 2000 and 2014. Age- and sex-standardized incidence rates of AMI declined from 322.4 (95% CI, 311.0-333.9) in 2000 to 174.6 (95% CI, 168.2-181.0) in 2014, representing an AAPC of -4.4% (95% CI, -4.2 to -4.6) and a period percent change of -46.6%. The AAPC for AMI in women was -4.6% (95% CI, -4.1 to -5.2) between 2000 and 2009 and declined to -2.3% (95% CI, -1.2 to -3.4) between 2010 and 2014. The AAPC for AMI in men was stable over the study period (-4.7% [95% CI, -4.4 to -4.9]). The AAPC for ST-segment-elevation MI hospitalization overall was -8.3% (95% CI, -8.0% to -8.6%).The AAPC in ST-segment-elevation MI changed among women in 2009 (2000-2009: -10.2% [95% CI, -9.3 to -11.1] and in 2010-2014: -5.2% [95% CI, -3.1 to -7.3]) while remaining stable among men (-8.0% [95% CI, -7.6 to -8.4]). The AAPC for non-ST-segment-elevation MI hospitalization was smaller than for ST-segment-elevation MI among both women and men (-1.9% [95% CI, -1.5 to -2.3] and -2.8% [95% CI, -2.5 to -3.2], respectively).
These results suggest that the incidence of hospitalized AMI declined between 2000 and 2014; however, declines in AMI have slowed among women in comparison with men in recent years. Determining unmet care needs among women may reduce these sex-based AMI disparities.
近几十年来，美国急性心肌梗死（AMI）的发病率有所下降，但性别差异仍然存在。在一个综合医疗服务体系中，我们研究了女性和男性 AMI 的时间趋势。
我们在 Kaiser Permanente Southern California 确定了≥35 岁的住院 AMI 患者。在每个日历年度（2000 年至 2014 年），根据主要出院诊断代码，确定 AMI 的首次住院，以及 ST 段抬高型心肌梗死和非 ST 段抬高型心肌梗死。使用 2010 年美国人口普查的直接调整计算每 100000 人年的年龄和性别标准化发病率。使用泊松回归计算平均年百分比变化（AAPC）和时期百分比变化，并进行趋势检验。
我们在 2000 年至 2014 年间确定了 45331 例 AMI 住院病例。AMI 的年龄和性别标准化发病率从 2000 年的 322.4（95%CI，311.0-333.9）降至 2014 年的 174.6（95%CI，168.2-181.0），AAPC 为-4.4%（95%CI，-4.2 至-4.6），时期百分比变化为-46.6%。2000 年至 2009 年，女性 AMI 的 AAPC 为-4.6%（95%CI，-4.1 至-5.2），而 2010 年至 2014 年则降至-2.3%（95%CI，-1.2 至-3.4）。同期男性 AMI 的 AAPC 稳定（-4.7%[95%CI，-4.4 至-4.9]）。整体 ST 段抬高型心肌梗死住院的 AAPC 为-8.3%（95%CI，-8.0%至-8.6%）。2009 年，女性 ST 段抬高型心肌梗死的 AAPC 发生变化（2000-2009 年：-10.2%[95%CI，-9.3 至-11.1]，2010-2014 年：-5.2%[95%CI，-3.1 至-7.3]），而男性的 AAPC 保持稳定（-8.0%[95%CI，-7.6 至-8.4]）。女性和男性的非 ST 段抬高型心肌梗死的 AAPC 均小于 ST 段抬高型心肌梗死（分别为-1.9%[95%CI，-1.5 至-2.3]和-2.8%[95%CI，-2.5 至-3.2]）。
这些结果表明，2000 年至 2014 年间，住院 AMI 的发病率有所下降；然而，近年来，女性 AMI 的下降速度较男性有所放缓。确定女性未满足的护理需求可能会减少这些基于性别的 AMI 差异。
