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The Association of Sex and Payer Status on Management and Subsequent Survival in Acute Myocardial Infarction
John G. Canto, MD, MSPH;
William J. Rogers, MD;
Nisha C. Chandra, MD;
William J. French, MD;
Hal V. Barron, MD;
Paul D. Frederick, MPH, MBA;
Charles Maynard, PhD;
Nathan R. Every, MD, MPH;
for the National Registry of Myocardial Infarction 2 Investigators
Arch Intern Med. 2002;162:587-593.
Background Previous reports have generally shown lower utilization of hospital
resources and lower survival in women than men with acute myocardial infarction.
However, to our knowledge, no reports have described the influence of payer
status on the treatment and outcome of women and men with acute myocardial
infarction.
Methods Baseline and clinical presenting characteristics, utilization of hospital
resources, and subsequent clinical outcome were ascertained among 327 040
women and men enrolled in a national registry of myocardial infarction from
June 1, 1994, to January 31, 1997. Separate Cox regression analyses were performed
for Medicare, Medicaid, health maintenance organizations, and commercial payer
groups to ascertain variables that were predictive of mortality in the study
population.
Results After adjustment for differences in age and other baseline and presenting
characteristics, women were significantly more likely than men to die in the
hospital (hazard ratio, 1.13; 95% confidence interval, 1.10-1.16), and this
difference was greatest among women with health maintenance organization and
commercial insurance (hazard ratios, 1.30 and 1.29, respectively), and least
among women with Medicare (hazard ratio, 1.07). However, after adjustment
for the additional effect on short-term survival of sex differences in the
utilization of both pharmacologic treatments administered within the first
24 hours and invasive cardiac procedures, the mortality difference observed
for women and men further diminished (hazard ratio, 1.08; 95% confidence interval,
1.05-1.10).
Conclusion In this large registry, we did not observe significant variations among
payer classes in management and mortality among women and men after acute
myocardial infarction.
From the Division of Cardiovascular Diseases and Acute Chest Pain Center,
Department of Medicine, University of Alabama Medical Center, Birmingham (Drs
Canto and Rogers); Department of Medicine, Johns Hopkins Bayview Medical Center,
Baltimore, Md (Dr Chandra); Division of Cardiology, Department of Medicine,
Harbor UCLA Medical Center, Torrance, Calif (Dr French); Division of Cardiology,
Department of Medicine, University of California at San Francisco (Dr Barron);
Division of Medical Affairs, Genentech, Inc, South San Francisco, Calif (Dr
Barron); and University of Washington Clinical Research Coordinating Center,
Seattle (Mr Frederick and Drs Maynard and Every). The list of hospitals participating
in the National Registry of Myocardial Infarction 2 can be obtained from ClinTrials
Research Inc, Lexington, Ky.
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