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Thirty-day mortality after AMI: effect modification by gender in outcome studies
Stefano Rosato1, Fulvia Seccareccia, Paola D'Errigo
1Department of Cerebro and Cardiovascular Disease, National Centre of Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Rome, Italy. stefano.rosato@iss.it
European Journal of Public Health
|December 1, 2009
Summary
Gender significantly impacts hospital performance in treating acute myocardial infarction (AMI). Stratifying by sex is crucial for accurate hospital quality comparisons and identifying gender-specific care disparities.
Area of Science:
- Cardiology
- Health Services Research
- Biostatistics
Background:
- Risk-adjustment models often overlook potential effect modifiers like gender.
- Comparative hospital evaluations require careful consideration of factors influencing outcomes.
Purpose of the Study:
- To investigate gender as an effect modifier in hospital performance assessments for 30-day in-hospital mortality after acute myocardial infarction (AMI).
Main Methods:
- Analysis of 38,544 AMI cases from 92 Italian hospitals (2004 data).
- Inclusion of comorbidities to define patient health status for adjustment models.
- Introduction of a gender-by-hospital interaction term to test for effect modification.
Main Results:
- Eleven hospitals demonstrated significant gender-based effect modification.
- One hospital showed excess mortality risk for women (OR=2.3) despite comparable overall rates.
- Ten hospitals had significant excess mortality, with variations in gender-specific impact (females only, males only, or both).
Conclusions:
- Gender significantly modifies hospital performance in AMI care.
- Stratifying by gender is essential for accurate comparative hospital evaluations.
- Investigating gender-based differences can reveal disparities in healthcare delivery and practices.
