Baljepally Vinila S, Wilson David C
Medicine, Health and Society, Vanderbilt University, Nashville, USA.
Internal Medicine, University of Tennessee Medical Center, Knoxville, USA.
Cureus. 2021 Jul 27;13(7):e16672. doi: 10.7759/cureus.16672. eCollection 2021 Jul.
Introduction Rural populations have higher rates of diabetes and hypertension (HTN) with disparities in outcomes among patients presenting to the emergency room with heart attack and stroke. However, it is unclear whether there are any sex differences among patients presenting for cardiac procedures from rural versus urban areas. Our study aimed to investigate gender-based differences in baseline characteristics and procedural outcomes among rural and urban residents presenting for cardiac catheterization and percutaneous interventional procedures. Methods We assessed baseline conditions and outcomes in 1775 patients who underwent cardiac catheterization and or Percutaneous Coronary Intervention at the University of Tennessee Medical Center between July 2018 to October 2019 from rural as well as urban areas. Baseline conditions assessed were diabetes, HTN, stroke, peripheral vascular disease, heart failure, and prior bypass surgery. Outcomes assessed were vascular/bleeding complications, duration of the procedure, and mortality. Results There were significant gender-based inter-group differences in outcomes between rural versus urban residents. In general, both rural and urban males had significantly longer procedure times and higher mortality than rural or urban females (P=0.01). Among females, rural women had longer procedure times than urban women. Bleeding complications were greater among rural residents than urban residents (p≤0.001), with rural females having the highest bleeding complication rate. Mortality was also higher among rural females compared to their urban counterparts (p=0.01). Significant gender-based inter-group differences were noted between rural versus urban residents. While the incidence of stroke was higher among rural and urban females compared to males, the peripheral vascular disease was more common among males. The history of coronary artery bypass graft (CABG) was more commonly seen among rural males than females. Rural and urban males had significantly longer procedure times than females, particularly urban females (P=0.01). Among women, rural females had longer procedure times, higher vascular/bleeding complications, and greater mortality than urban females. Mortality was higher among rural men and women compared to urban men or women (p=0.01). Rural women had the highest bleeding/vascular complications. Conclusions We found significant gender-based differences between rural versus urban patients. While rural females had a higher incidence of stroke, peripheral vascular disease and a history of CABG were more commonly seen among rural males. Overall, rural males had higher mortality than females (P=0.01). Among women, rural females had longer procedure times, higher bleeding complications, and greater mortality than urban females. Being aware of such gender-based differences may help physicians take steps to improve outcomes. Information derived from our study may also be useful for policymakers in directing healthcare funding to lower gaps in the care of patients such as those with peripheral vascular disease, ultimately leading to better health outcomes.
引言
农村人口患糖尿病和高血压（HTN）的比例较高，在因心脏病发作和中风前往急诊室就诊的患者中，治疗结果存在差异。然而，目前尚不清楚来自农村和城市地区接受心脏手术的患者之间是否存在性别差异。我们的研究旨在调查农村和城市居民在接受心脏导管插入术和经皮介入手术时，基线特征和手术结果的性别差异。
方法
我们评估了2018年7月至2019年10月期间在田纳西大学医学中心接受心脏导管插入术和/或经皮冠状动脉介入治疗的1775名农村和城市地区患者的基线状况和治疗结果。评估的基线状况包括糖尿病、高血压、中风、外周血管疾病、心力衰竭和既往搭桥手术。评估的结果包括血管/出血并发症、手术持续时间和死亡率。
结果
农村和城市居民在治疗结果上存在显著的性别组间差异。总体而言，农村和城市男性的手术时间显著长于农村或城市女性，死亡率也更高（P=0.01）。在女性中，农村女性的手术时间比城市女性长。农村居民的出血并发症高于城市居民（p≤0.001），农村女性的出血并发症发生率最高。与城市女性相比，农村女性的死亡率也更高（p=0.01）。农村和城市居民之间存在显著的性别组间差异。虽然农村和城市女性的中风发病率高于男性，但外周血管疾病在男性中更为常见。冠状动脉搭桥术（CABG）的病史在农村男性中比女性更常见。农村和城市男性的手术时间显著长于女性，尤其是城市女性（P=0.01）。在女性中，农村女性的手术时间更长，血管/出血并发症更高，死亡率也高于城市女性。与城市男性或女性相比，农村男性和女性的死亡率更高（p=0.01）。农村女性的出血/血管并发症最高。
结论
我们发现农村和城市患者之间存在显著的性别差异。虽然农村女性中风的发病率较高，但外周血管疾病和冠状动脉搭桥术病史在农村男性中更为常见。总体而言，农村男性的死亡率高于女性（P=0.01）。在女性中，农村女性的手术时间更长，出血并发症更高，死亡率也高于城市女性。了解这些性别差异可能有助于医生采取措施改善治疗结果。我们研究得出的信息也可能有助于政策制定者将医疗保健资金用于缩小患者护理差距，如外周血管疾病患者，最终带来更好的健康结果。
