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Changes From 1994 to 2006

Viola Vaccarino, MD, PhD; Lori Parsons, BS; Eric D. Peterson, MD; William J. Rogers, MD; Catarina I. Kiefe, MD, PhD; John Canto, MD

Arch Intern Med. 2009;169(19):1767-1774.

Background  Previous studies have shown that women younger than 55 years have higher hospital mortality rates after acute myocardial infarction (MI) than age-matched men. We examined whether such mortality differences have decreased in recent years.

Methods  We investigated temporal trends in the hospital case-fatality rates of MI by sex and age from June 1, 1994, through December 31, 2006. The study population included 916 380 patients from the National Registry of Myocardial Infarction with a confirmed diagnosis of MI.

Results  In-hospital mortality decreased markedly between 1994 and 2006 in all patients but more so in women than men. The mortality reduction in 2006 relative to 1994 was largest in women younger than 55 years (52.9%) and lowest in men younger than 55 years (33.3%). In patients younger than 55 years, the absolute decrease in mortality was 3 times larger in women than men (2.7% vs 0.9%). As a result, the excess mortality in younger women (<55 years) compared with men was less pronounced in 2004-2006 (unadjusted odds ratio, 1.32; 95% confidence interval, 1.07-1.67) than it was in 1994-1995 (unadjusted odds ratio, 1.93; 95% confidence interval, 1.67-2.24). The sex difference in mortality decrease was lower in older patients (P = .004 for the interaction among sex, age, and year). Changes in comorbidity and clinical severity features at admission accounted for more than 90% of these mortality trends.

Conclusions  In recent years, women, particularly younger ones, experienced larger improvements in hospital mortality after MI than men. The narrowing of the mortality gap between younger women and men is largely attributable to temporal changes in risk profiles.

Author Affiliations: Department of Medicine, Division of Cardiology, Emory School of Medicine, and Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia (Dr Vaccarino); ICON Clinical Research, Lifecycle Sciences Group, San Francisco, California (Ms Parsons); Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina (Dr Peterson); Divisions of Cardiovascular Disease (Dr Rogers) and Preventive Medicine (Dr Kiefe), University of Alabama at Birmingham; and Watson Clinic, Lakeland, Florida (Dr Canto).

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