Department of Medicine, McGill University and Centre for Outcomes Research and Evaluation Research Institute, McGill University Health Centre Montreal Quebec Canada.
Faculties of Nursing, Medicine and School of Public Health University of Alberta Edmonton Canada.
J Am Heart Assoc. 2023 Aug;12(15):e028553. doi: 10.1161/JAHA.122.028553. Epub 2023 Jul 25.
Background Gender-related factors are psycho-socio-cultural characteristics and are associated with adverse clinical outcomes in acute myocardial infarction, independent of sex. Whether sex- and gender-related factors contribute to the substantial heterogeneity in hospital length of stay (LOS) among patients with non-ST-segment-elevation myocardial infarction remains unknown. Methods and Results This observational cohort study combined and analyzed data from the GENESIS-PRAXY (Gender and Sex Determinants of Cardiovascular Disease: From Bench to Beyond Premature Acute Coronary Syndrome study), EVA (Endocrine Vascular Disease Approach study), and VIRGO (Variation in Recovery: Role of Gender on Outcomes of Young AMI [Acute Myocardial Infarction] Patients study) cohorts of adults hospitalized across Canada, the United States, Switzerland, Italy, Spain, and Australia for non-ST-segment-elevation myocardial infarction. In total, 5219 participants were assessed for eligibility. Sixty-three patients were excluded for missing LOS, and 2938 were excluded because of no non-ST-segment-elevation myocardial infarction diagnosis. In total, 2218 participants were analyzed (66% women; mean±SD age, 48.5±7.9 years; 67.8% in the United States). Individuals with longer LOS (51%) were more likely to be White race, were more likely to have diabetes, hypertension, and a lower income, and were less likely to be employed and have completed secondary education. No univariate association between sex and LOS was observed. In the adjusted multivariable model, age (0.62 d/10 y; <0.001), unemployment (0.63 days; =0.01), and some of countries included relative to Canada (Italy, 4.1 days; Spain, 1.7 days; and the United States, -1.0 days; all <0.001) were independently associated with longer LOS. Medical history mediated the effect of employment on LOS. No interaction between sex and employment was observed. Longer LOS was associated with increased 12-month all-cause mortality. Conclusions Older age, unemployment, and country of hospitalization were independent predictors of LOS, regardless of sex. Individuals employed with non-ST-segment-elevation myocardial infarction were more likely to experience shorter LOS. Sociocultural factors represent a potential target for improvement in health care expenditure and resource allocation.
性别相关因素是心理社会文化特征，与急性心肌梗死的不良临床结局有关，而与性别无关。性别相关因素是否导致非 ST 段抬高型心肌梗死患者住院时间（LOS）存在显著异质性尚不清楚。
本观察性队列研究合并分析了来自加拿大、美国、瑞士、意大利、西班牙和澳大利亚的 GENESIS-PRAXY（性别和性决定因素对心血管疾病的影响：从基础到过早急性冠状动脉综合征研究）、EVA（内分泌血管疾病方法研究）和 VIRGO（年轻急性心肌梗死[AMI]患者康复中的性别差异研究）队列中因非 ST 段抬高型心肌梗死住院的成年人的数据。共有 5219 名患者符合入选标准。因 LOS 缺失排除 63 例患者，因无非 ST 段抬高型心肌梗死诊断排除 2938 例患者。最终共分析了 2218 名患者（66%为女性；平均年龄±标准差为 48.5±7.9 岁；67.8%来自美国）。LOS 较长的患者（51%）更有可能为白种人，更有可能患有糖尿病、高血压和较低的收入，且更不可能就业和完成中学教育。未观察到性别与 LOS 之间存在单变量关联。在调整后的多变量模型中，年龄（每增加 10 岁，增加 0.62 天；<0.001）、失业（增加 0.63 天；=0.01）和部分国家（与加拿大相比，意大利增加 4.1 天；西班牙增加 1.7 天；美国减少 1.0 天；均<0.001）与 LOS 延长独立相关。就业对 LOS 的影响可通过医疗史来解释。未观察到性别与就业之间的相互作用。较长的 LOS 与 12 个月全因死亡率的增加相关。
无论性别如何，年龄较大、失业和住院国家都是 LOS 的独立预测因素。患有非 ST 段抬高型心肌梗死并就业的个体更有可能经历较短的 LOS。社会文化因素是改善医疗支出和资源分配的潜在目标。
