Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut, USA.
Department of Neurology, KY Neuroscience Institute, University of Kentucky, Lexington, Kentucky, USA.
J Womens Health (Larchmt). 2022 Jun;31(6):834-841. doi: 10.1089/jwh.2021.0471. Epub 2022 Feb 11.
The relationship between cardiovascular disease risk factors (CVD-RFs) and health care utilization may differ by sex. We determined whether having more CVD-RFs was associated with all-cause emergency department (ED) visits and all-cause hospitalizations for women and men with prior stroke/transient ischemic attack (TIA). In this cross-sectional study, we used nationally representative Medical Expenditure Panel Survey (2012-2015) data for persons aged ≥18 years with a prior stroke/TIA. CVD-RF summary scores include six self-reported factors (hypertension, diabetes, high cholesterol, physical inactivity, smoking, and obesity). Sex-specific covariate-adjusted logistic regression models assessed associations between CVD-RF scores and having one or more all-cause ED visits and one or more all-cause hospitalizations. The weighted sample represents 9.1 million individuals (mean age 66.6 years; 54.3% women). Prevalence of low (0-1 risk factors), intermediate (2-3), and high (4-6) CVD-RF scores was 19.4%, 60.5%, and 20.1% for women and 14.6%, 60.2%, and 25.2% for men, respectively. Women having intermediate and high scores had a 1.58-fold (95% confidence interval [CI], 1.14-2.18) and 2.21-fold (95% CI, 1.50-3.25) increased odds of ED visits compared with women with low scores. Women with high CVD-RF scores had a 2.18-fold (95% CI, 1.42-3.34) increased odds of hospitalizations, but there was no association for women with intermediate CVD-RF profiles. There was no association between CVD-RF scores and either outcome for men. Women, but not men, with high and intermediate CVD-RF profiles had increased odds of all-cause ED visits; women with high CVD-RF profiles had increased odds of all-cause hospitalizations. The burden of CVD-RFs may be a sex-specific predictor of higher health care utilization in women with a history of stroke/TIA.
心血管疾病风险因素（CVD-RFs）与医疗保健利用之间的关系可能因性别而异。我们确定了患有更多 CVD-RFs 是否与既往有中风/短暂性脑缺血发作（TIA）的女性和男性的全因急诊就诊和全因住院有关。在这项横断面研究中，我们使用了全国代表性的医疗支出调查（2012-2015 年）数据，调查了年龄≥18 岁且既往有中风/TIA 的患者。CVD-RF 综合评分包括六项自我报告的因素（高血压、糖尿病、高胆固醇、身体不活动、吸烟和肥胖）。性别特异性协变量调整的逻辑回归模型评估了 CVD-RF 评分与全因急诊就诊次数（一次或更多）和全因住院次数（一次或更多）之间的关联。加权样本代表了 910 万人（平均年龄 66.6 岁；54.3%为女性）。女性低（0-1 个危险因素）、中（2-3 个）和高（4-6 个）CVD-RF 评分的患病率分别为 19.4%、60.5%和 20.1%，男性分别为 14.6%、60.2%和 25.2%。与低评分的女性相比，中评分和高评分的女性急诊就诊的几率分别高出 1.58 倍（95%置信区间[CI]，1.14-2.18）和 2.21 倍（95% CI，1.50-3.25）。高 CVD-RF 评分的女性住院的几率增加了 2.18 倍（95% CI，1.42-3.34），但中 CVD-RF 评分的女性没有关联。对于男性，CVD-RF 评分与任何结果都没有关联。女性（而非男性）具有高和中 CVD-RF 评分的患者全因急诊就诊的几率更高；高 CVD-RF 评分的女性全因住院的几率更高。在有中风/TIA 病史的女性中，CVD-RFs 的负担可能是医疗保健利用较高的一个特定于性别的预测因素。
