Vynckier Pieter, Van Wilder Lisa, Kotseva Kornelia, Wood David, Gevaert Sofie, Clays Els, De Bacquer Dirk, De Smedt Delphine
Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.
Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.
Int J Cardiol. 2023 Jan 15;371:452-459. doi: 10.1016/j.ijcard.2022.09.010. Epub 2022 Sep 8.
This study aimed to provide an overview on contemporary gender differences in HRQoL/psychological distress and their relationship with comorbidity burden among European coronary heart disease (CHD) patients.
Analyses were based on the cross-sectional ESC EORP EUROASPIRE V survey. Consecutive patients (aged 18-80 years), hospitalized for a first or recurrent coronary event were included in this study. Data at hospital discharge and at follow-up (6 to 24 months after hospitalisation) were collected.
Data were available for 8261 patients of which 25.8% women. Overall, women reported a worse EQ-5D-5L index score (0.73 vs. 0.81; P < 0.001), EQ-VAS (63.1 vs. 66.0; P = 0.001), global HeartQoL (1.94 vs. 2.26; P < 0.001), physical HeartQoL (1.96 vs. 2.30; P < 0.001), emotional HeartQoL (1.88 vs. 2.18; P < 0.001), HADS-A (6.69 vs. 4.99; P < 0.001), and HADS-D (5.73 vs. 4.62; P < 0.001) compared to men. Also, women were more likely to have comorbidities compared to men (1 comorbidity: 38.7% vs. 35.0%, 2 comorbidities: 9.7% vs. 7.5%; P < 0.001). There is indication that heart failure (EQ-VAS) and diabetes (global HeartQoL, emotional HeartQoL, physical HeartQoL, and HADS-D) interacted with gender and modulate the relationship with HRQoL, in disfavour of women.
Substantial gender-based health inequalities in terms of HRQoL and psychological distress were found, in disfavour of women. Women had worse HRQoL and psychological distress outcomes when having comorbidities. To a limited extent, comorbidity and women had a negative/synergistic effect on HRQoL. Special attention should be given to this population groups within daily clinical practice.
本研究旨在概述欧洲冠心病（CHD）患者在健康相关生活质量/心理困扰方面的当代性别差异及其与合并症负担的关系。
分析基于横断面的欧洲心脏病学会（ESC）欧洲动脉粥样硬化干预与研究项目（EUROASPIRE）V调查。本研究纳入了因首次或复发性冠状动脉事件住院的连续患者（年龄18 - 80岁）。收集了出院时及随访（住院后6至24个月）的数据。
共有8261例患者的数据可用，其中女性占25.8%。总体而言，女性报告的EQ - 5D - 5L指数得分更低（0.73对0.81；P < 0.001），EQ视觉模拟量表（EQ - VAS）得分更低（63.1对66.0；P = 0.001），整体心脏生活质量（HeartQoL）得分更低（1.94对2.26；P < 0.001），身体方面的心脏生活质量得分更低（1.96对2.30；P < 0.001），情感方面的心脏生活质量得分更低（1.88对2.18；P < 0.001），医院焦虑抑郁量表（HADS - A）得分更高（6.69对4.99；P < 0.001），以及HADS - D得分更高（5.73对4.62；P < 0.001）。此外，与男性相比，女性更易患有合并症（一种合并症：38.7%对35.0%，两种合并症：9.7%对7.5%；P < 0.001）。有迹象表明，心力衰竭（EQ - VAS）和糖尿病（整体心脏生活质量、情感方面的心脏生活质量、身体方面的心脏生活质量以及HADS - D）与性别相互作用，并调节了与健康相关生活质量的关系，对女性不利。
在健康相关生活质量和心理困扰方面发现了显著的基于性别的健康不平等，对女性不利。患有合并症时，女性的健康相关生活质量和心理困扰结果更差。在一定程度上，合并症和女性性别对健康相关生活质量有负面/协同作用。在日常临床实践中应特别关注这一人群。
