Sex Differences in Temporal Trends and Risk Factors of Aortic Dissection in Taiwan

Area of Science:

• Cardiovascular Medicine
• Epidemiology
• Sex Differences in Health

Background:

• Sex disparities in aortic dissection (AD) epidemiology are known, but differences in comorbidity and risk factor associations remain unclear.
• This study investigates temporal trends and risk factors of AD, specifically examining sex-based variations.

Purpose of the Study:

• To evaluate temporal trends in aortic dissection (AD) incidence and mortality stratified by sex.
• To identify and compare risk factors and comorbidities associated with AD in men and women.

Main Methods:

• Utilized Taiwanese universal health insurance claims data linked to the National Death Registry (2005-2018).
• Conducted a case-control analysis with matched controls, employing conditional logistic regression to assess risk factors and sex differences in 16,368 men and 7,052 women with newly diagnosed AD.
• Analyzed temporal trends in 30-day mortality based on sex and surgical treatment.

Main Results:

• Annual AD incidence was higher in men (12.69/100,000) than women (5.34/100,000).
• 30-day mortality was greater in women (18.1%) versus men (14.1%), particularly in non-surgically treated patients.
• Atrial fibrillation, chronic kidney disease, and coronary artery bypass graft surgery showed stronger associations with AD in women than in men.

Conclusions:

• Women with AD experience higher 30-day mortality, with significant sex differences noted primarily in non-surgically treated patients.
• Specific comorbidities, including atrial fibrillation and chronic kidney disease, and prior coronary artery bypass graft surgery, present a heightened risk for AD in women.
• These findings underscore the need for targeted attention to sex-specific risk factors and outcomes in aortic dissection management.