National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China.
Shenzhen Clinical Research Center for Cardiovascular Diseases Fuwai Hospital Chinese Academy of Medical Sciences, Shenzhen Shenzhen China.
J Am Heart Assoc. 2023 Oct 17;12(20):e030203. doi: 10.1161/JAHA.123.030203. Epub 2023 Oct 7.
Background Knowledge gaps remain in how gender-related socioeconomic inequality affects sex disparities in cardiovascular diseases (CVD) prevention and outcome. Methods and Results Based on a nationwide population cohort, we enrolled 3 737 036 residents aged 35 to 75 years (2014-2021). Age-standardized sex differences and the effect of gender-related socioeconomic inequality (Gender Inequality Index) on sex disparities were explored in 9 CVD prevention indicators. Compared with men, women had seemingly better primary prevention (aspirin usage: relative risk [RR], 1.24 [95% CI, 1.18-1.31] and statin usage: RR, 1.48 [95% CI, 1.39-1.57]); however, women's status became insignificant or even worse when adjusted for metabolic factors. In secondary prevention, the sex disparities in usage of aspirin (RR, 0.65 [95% CI, 0.63-0.68]) and statin (RR, 0.63 [95% CI, 0.61-0.66]) were explicitly larger than disparities in usage of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (RR, 0.88 [95% CI, 0.84-0.91]) or β blockers (RR, 0.67 [95% CI, 0.63-0.71]). Nevertheless, women had better hypertension awareness (RR, 1.09 [95% CI, 1.09-1.10]), similar hypertension control (RR, 1.01 [95% CI, 1.00-1.02]), and lower CVD mortality (hazard ratio, 0.46 [95% CI, 0.45-0.47]). Heterogeneities of sex disparities existed across all subgroups. Significant correlations existed between regional Gender Inequality Index values and sex disparities in usage of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (Spearman correlation coefficient, =-0.57, =0.0013), hypertension control (=-0.62, =0.0007), and CVD mortality (=0.45, =0.014), which remained significant after adjusting for economic factors. Conclusions Notable sex disparities remain in CVD prevention and outcomes, with large subgroup heterogeneities. Gendered socioeconomic factors could reinforce such disparities. A sex-specific perspective factoring in socioeconomic disadvantages could facilitate more targeted prevention policy making.
背景知识 ：关于性别相关的社会经济不平等如何影响心血管疾病 (CVD) 预防和结局方面的性别差异，目前仍存在知识空白。
方法和结果 ：基于一项全国性人群队列研究，我们纳入了 3737036 名 35-75 岁的居民（2014-2021 年）。我们探讨了 9 项 CVD 预防指标中与性别相关的社会经济不平等（性别不平等指数）对性别差异的影响。与男性相比，女性在初级预防方面表现似乎更好（阿司匹林使用率：相对风险 [RR]，1.24 [95%CI，1.18-1.31]；他汀类药物使用率：RR，1.48 [95%CI，1.39-1.57]）；然而，当调整代谢因素后，女性的地位变得不那么显著，甚至更差。在二级预防中，阿司匹林（RR，0.65 [95%CI，0.63-0.68]）和他汀类药物（RR，0.63 [95%CI，0.61-0.66]）使用率的性别差异明显大于血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂（RR，0.88 [95%CI，0.84-0.91]）或β受体阻滞剂（RR，0.67 [95%CI，0.63-0.71]）的使用率性别差异。然而，女性的高血压知晓率（RR，1.09 [95%CI，1.09-1.10]）更高，高血压控制率（RR，1.01 [95%CI，1.00-1.02]）相似，且 CVD 死亡率更低（风险比，0.46 [95%CI，0.45-0.47]）。所有亚组均存在性别差异的异质性。区域性别不平等指数值与血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂（Spearman 相关系数，=-0.57，=0.0013）、高血压控制（=-0.62，=0.0007）和 CVD 死亡率（=-0.45，=0.014）的使用率之间存在显著相关性，在调整经济因素后仍具有统计学意义。
结论 ：在 CVD 预防和结局方面，仍然存在显著的性别差异，且亚组间存在较大异质性。性别相关的社会经济因素可能会加剧这种差异。从社会经济劣势的角度出发，制定有针对性的性别特定预防政策，可能有助于改善这种情况。
