Vicent Lourdes, Martín de la Mota Sanz David, Rosillo Nicolás, Peñaloza-Martínez Eduardo, Moreno Guillermo, Bernal José Luis, Elola Javier, Bueno Héctor
Cardiology Department, Hospital Universitario 12 de Octubre and Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain.
CIBER de enfermedades CardioVasculares (CIBERCV), Madrid, Spain.
Eur Heart J Qual Care Clin Outcomes. 2023 Feb 28;9(2):184-193. doi: 10.1093/ehjqcco/qcac020.
There is controversy regarding the incidence and outcomes of pulmonary embolism (PE) according to sex. Our aim was to address sex differences in temporal trends in main and secondary hospital PE diagnoses, management and case fatality rates (CFR).
Retrospective analysis of Spain´s National Healthcare System hospital database, years 2003-2019, for patients ≥18 years with main or secondary PE diagnosis. Trends by sex in hospital diagnosis, use of procedures, and CFRs were analysed by joinpoint and Poisson regression models. Of 339 469 PE diagnoses, 52% were in women. Sixty-five percent were main diagnosis, 35.2% secondary. Total annual diagnoses and frequentation rates increased similarly in men and women: average annual percent change (AAPC): 2.0% (95% CI, 1.3-2.6; P < 0.005). Secondary PEs were more common in men (37.8% vs. 32.9%, P < 0.001). Men showed greater comorbidity than women (Charlson index 2.22 ± 0.01 vs. 1.74 ± 0.01, P < 0.001), particularly cancer in the secondary diagnosis group (40.9% vs. 31.6%, P < 0.001). CFRs for PE as main diagnosis were comparable and decreased in parallel in men (from 13.8% in 2003 to 7.3% in 2019) and women (from 13.1% in 2003 to 6.9% in 2019). However, for PE as secondary diagnosis, CFRs remained higher (P < 0.001) in men (from 42.5% in 2003 to 26.2% in 2019) than women (from 34.4% in 2003 to 22.8% in 2019).
PE hospital diagnosis increased significantly between 2003 and 2019 in men and women for both main and secondary diagnosis. Although in-hospital CFR decreased one third still remains very high, especially in men with secondary PE diagnosis.
关于肺栓塞（PE）的发病率和预后在性别上存在争议。我们的目的是探讨男女在主要和次要医院PE诊断、治疗及病死率（CFR）的时间趋势上的性别差异。
对西班牙国家医疗系统2003 - 2019年≥18岁主要或次要诊断为PE的患者的医院数据库进行回顾性分析。通过连接点和泊松回归模型分析男女在医院诊断、诊疗程序使用及CFR方面的趋势。在339469例PE诊断中，52%为女性。65%为主要诊断，35.2%为次要诊断。男女每年的总诊断数和就诊率增长相似：平均年变化百分比（AAPC）：2.0%（95%CI，1.3 - 2.6；P < .005）。次要PE在男性中更常见（37.8%对32.9%，P < .001）。男性的合并症比女性更严重（Charlson指数2.22±0.01对1.74±0.01，P < .001），尤其是在次要诊断组中癌症（40.9%对31.6%，P < .001）。作为主要诊断的PE的CFR相当，且在男性（从2003年的13.8%降至2019年的7.3%）和女性（从2003年的13.1%降至2019年的6.9%）中平行下降。然而，对于次要诊断的PE，男性的CFR仍然更高（P < .001）（从2003年的42.5%降至2019年的26.2%），高于女性（从2003年的34.4%降至2019年的22.8%）。
2003年至2019年期间，男女主要和次要诊断的PE医院诊断数均显著增加。尽管住院CFR下降了三分之一，但仍然很高，尤其是次要PE诊断的男性。
