Roger V L, Jacobsen S J, Pellikka P A, Miller T D, Bailey K R, Gersh B J
Mayo Medical Center, Rochester, Minnesota 55905, USA.
J Am Coll Cardiol. 1998 Aug;32(2):345-52. doi: 10.1016/s0735-1097(98)00229-0.
We sought to examine the utilization of exercise stress testing in relation to age and gender in a population-based setting.
The utilization of noninvasive procedures has been shown to be associated with the subsequent use of invasive procedures. Yet, there are no population-based data on the utilization of stress testing; in particular, although gender differences in the use of invasive procedures have been reported, the use of noninvasive procedures has not been examined in relation to gender.
In Olmsted County, Minnesota, passive surveillance of the medical care of the community is provided through the Rochester Epidemiology Project. A population-based cohort of Olmsted County residents undergoing exercise tests was identified. The medical records of residents with prevalent and incident exercise tests in 1987 and 1988 were reviewed. For persons with an initial test (incidence cohort), data on clinical presentation, test indications and results were abstracted. Stress test utilization rates were calculated, and crude rates were directly adjusted to the age distribution of the 1980 U.S. population. To help interpret patterns of use at the population level, coronary heart disease mortality rates (International Classification of Diseases, 9th revision, codes 410 to 414) were calculated (crude and directly adjusted to the overall age distribution of the 1980 U.S. population) and used as an indicator of coronary disease burden.
A total of 2,624 tests were performed. The crude utilization rate (per 100,000) was 1,888 for men and 703 for women (rate ratio for men over women 2.7, 95% confidence interval [CI] 2.5 to 2.9); it remained significantly higher in men across all age strata. The crude incidence rate (per 100,000) of initial stress tests was 1,112 for men and 517 for women (rate ratio 2.2, 95% CI 1.9 to 2.4). For both men and women, the incidence increased with age; however, incidence remained lower in women in all age strata. At the time that they underwent an initial test, women were more symptomatic and had poorer exercise performance than men. The rate ratio of men over women for coronary heart disease mortality was 1.1 (95% CI 0.9 to 1.2). The age-adjusted rate ratios for stress test utilization were 2.8 (95% CI 2.5 to 3.0), and that for coronary heart disease mortality was 1.9 (95% CI 1.7 to 2.2).
These population-based data show that during the study period, the utilization of stress testing in Olmsted County was lower in women than in men. Women in the incidence cohort were older and more symptomatic and had poorer exercise performance than men. Such differences should be considered when examining the utilization of subsequent invasive procedures according to gender.
我们试图在基于人群的背景下，研究运动负荷试验的使用与年龄和性别的关系。
已表明无创检查的使用与随后有创检查的使用相关。然而，尚无基于人群的运动负荷试验使用数据；特别是，虽然已有关于有创检查使用的性别差异报道，但无创检查的使用与性别的关系尚未得到研究。
在明尼苏达州奥尔姆斯特德县，通过罗切斯特流行病学项目对社区医疗进行被动监测。确定了一组接受运动试验的奥尔姆斯特德县居民队列。回顾了1987年和1988年进行过运动试验的现患和新发病例居民的病历。对于初次检查者（新发病例队列），提取了临床表现、检查指征和结果的数据。计算运动负荷试验使用率，并将粗率直接调整为1980年美国人口的年龄分布。为了有助于解释人群层面的使用模式，计算了冠心病死亡率（国际疾病分类，第9版，编码410至414）（粗率并直接调整为1980年美国人口的总体年龄分布），并将其用作冠心病负担的指标。
共进行了2624次检查。男性的粗使用率（每10万人）为1888，女性为703（男性与女性的率比为2.7，95%置信区间[CI]为2.5至2.9）；在所有年龄层中，男性的使用率仍显著高于女性。初次运动负荷试验的粗发病率（每10万人）男性为1112，女性为517（率比为2.2，95%CI为1.9至2.4）。男性和女性的发病率均随年龄增加；然而，在所有年龄层中，女性的发病率仍然较低。在进行初次检查时，女性比男性症状更明显，运动能力更差。男性与女性冠心病死亡率的率比为1.1（95%CI为0.9至1.2）。运动负荷试验使用率的年龄调整率比为2.8（95%CI为2.5至3.0），冠心病死亡率的年龄调整率比为1.9（95%CI为1.7至2.2）。
这些基于人群的数据表明，在研究期间，奥尔姆斯特德县运动负荷试验的使用率女性低于男性。新发病例队列中的女性比男性年龄更大，症状更明显，运动能力更差。在根据性别研究随后有创检查的使用情况时，应考虑这些差异。
