CTSU, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
Heart. 2022 Feb;108(4):292-299. doi: 10.1136/heartjnl-2021-318988. Epub 2021 May 27.
To investigate gender differences in the use of diagnostic and therapeutic procedures for acute ischaemic heart disease (IHD) in Chinese adults and assess whether socioeconomic or health system factors contribute to such differences.
In 2004-2008, the China Kadoorie Biobank recruited 512 726 adults from 10 diverse areas in China. Data for 38 928 first hospitalisations with IHD (2911 acute myocardial infarction (AMI), 9817 angina and 26 200 other IHD) were obtained by electronic linkage to health insurance records until 31 December 2016. Multivariate Poisson regression models were used to estimate women-to-men rate ratios (RRs) of having cardiac enzyme tests, coronary angiography and coronary revascularisation.
Among the 38 928 individuals (61% women) with IHD admissions, women were less likely to have AMI (5% vs 12%), but more likely to have angina (26% vs 24%) or other IHD (69% vs 64%). For admissions with AMI, there were no differences in the use of cardiac enzymes between women and men (RR=1.00; 95% CI, 0.97 to 1.03), but women had lower use of coronary angiography (0.80, 0.68 to 0.93) and coronary revascularisation (0.85, 0.74 to 0.99). For angina, the corresponding RRs were: 0.97 (0.94 to 1.00), 0.66 (0.59 to 0.74) and 0.56 (0.47 to 0.67), respectively; while for other IHD, they were 0.97 (0.94 to 1.00), 0.87 (0.76 to 0.99) and 0.61 (0.51 to 0.73), respectively. Adjusting for socioeconomic and health system factors did not significantly alter the women-to-men RRs.
Among Chinese adults hospitalised with acute IHD, women were less likely than men to have coronary angiography and revascularisation, but socioeconomic and health system factors did not contribute to these differences.
探讨中国成年人急性缺血性心脏病（IHD）诊断和治疗方法的性别差异，并评估社会经济或卫生系统因素是否导致了这些差异。
2004-2008 年，中国慢性病前瞻性研究在全国 10 个不同地区招募了 512726 名成年人。通过电子链接医疗保险记录，获取了 38928 例首次 IHD 住院（2911 例急性心肌梗死（AMI）、9817 例心绞痛和 26200 例其他 IHD）的数据，直至 2016 年 12 月 31 日。采用多变量泊松回归模型估计女性与男性进行心肌酶检测、冠状动脉造影和冠状动脉血运重建的比率（RR）。
在 38928 例 IHD 住院患者（61%为女性）中，女性发生 AMI 的可能性较低（5%比 12%），但发生心绞痛（26%比 24%）或其他 IHD（69%比 64%）的可能性较高。对于 AMI 住院患者，女性与男性之间心肌酶的使用无差异（RR=1.00；95%CI，0.97 至 1.03），但女性接受冠状动脉造影（0.80，0.68 至 0.93）和冠状动脉血运重建（0.85，0.74 至 0.99）的可能性较低。对于心绞痛，相应的 RR 分别为：0.97（0.94 至 1.00）、0.66（0.59 至 0.74）和 0.56（0.47 至 0.67）；对于其他 IHD，相应的 RR 分别为：0.97（0.94 至 1.00）、0.87（0.76 至 0.99）和 0.61（0.51 至 0.73）。调整社会经济和卫生系统因素后，女性与男性的 RR 无显著变化。
在中国成年人急性 IHD 住院患者中，女性接受冠状动脉造影和血运重建的可能性低于男性，但社会经济和卫生系统因素并未导致这种差异。
