Sex, Race, and Life Expectancy After Acute Myocardial Infarction

Aug 04, 2015
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Authors:
Bucholz EM, Normand SL, Wang Y, Ma S, Lin H, Krumholz HM.
Citation:
Life Expectancy and Years of Potential Life Lost After Acute Myocardial Infarction by Sex and Race: A Cohort-Based Study of Medicare Beneficiaries. J Am Coll Cardiol 2015;66:645-655.
Summary By:
Debabrata Mukherjee, MD, FACC

Study Questions:

What are the sex and race differences in long-term survival after acute myocardial infarction (AMI) using life expectancy and years of potential life lost (YPLLs) to account for differences in population-based life expectancy?

Methods:

The investigators used data from the Cooperative Cardiovascular Project, a prospective cohort study of Medicare beneficiaries hospitalized for AMI between 1994 and 1995 (n = 146,743), and calculated life expectancy and YPLLs using Cox proportional hazards regression with extrapolation using exponential models.

Results:

Of the 146,743 patients with AMI, 48.1% were women and 6.4% were black; the average age was 75.9 years. Post-AMI life expectancy estimates were similar for men and women of the same race, but lower for black patients than white patients. On average, women lost 10.5% (standard error [SE] 0.3%) more of their expected life than men, and black patients lost 6.2% (SE 0.6%) more of their expected life than white patients. After adjustment, women still lost an average of 7.8% (0.3%) more of their expected life than men, but black race became associated with a survival advantage, suggesting that racial differences in YPLLs were largely explained by differences in clinical presentation and treatment between black and white patients.

Conclusions:

The authors concluded that women and black patients lost more years of life after AMI, on average, than men and white patients.

Perspective:

This study found large differences in life expectancy and YPLLs between sexes and races with women and black patients having the largest YPLLs, and sheds new insight on sex and racial differences in survival after AMI. Whereas much of the racial difference in YPLLs could be explained by differences in clinical presentation and treatment between black and white patients, this was not true for the observed sex differences. We need strategies that reduce the higher risk factor burden in women and improve long-term management of heart disease in women.

Keywords: Acute Coronary Syndrome, African Americans, Geriatrics, Life Expectancy, Medicare, Myocardial Infarction, Risk Factors, Sex Characteristics, Survival, Treatment Outcome, Women


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