Gender differences in the sequelae of hospitalization for acute myocardialinfarction among older adults

OBJECTIVE: To examine the effect of gender differences among older adults h ospitalized for an acute myocardial infarction (AMI) on subsequent health o utcomes. DESIGN: Secondary analysis of the Longitudinal Study on Aging. Data from ba seline interviews (1984) and three biennial (1986, 1988, and 1990) re-inter views were linked to Medicare hospitalization and National Death Index reco rds for 1984-1991. PARTICIPANTS: A total of 6071 community-dwelling adults aged 70 years or ol der at baseline. METHODS: Pooled and stratified multivariable models were used to examine ge nder differences in the independent effects of being hospitalized for an AM I on all- cause mortality, the risk and volume of subsequent hospitalizatio n, and increases in the number of functional limitations. Two comparison gr oups were used. RESULTS: Three hundred fifty-seven AMI cases (6%; 172 women and 185 men) we re compared with 3976 hospitalized controls and 1738 nonhospitalized contro ls. The risk of ah-cause mortality for AMI cases was greater than that for either hospitalized controls or nonhospitalized controls (referent), and th is increased risk was significantly (P <.001) stronger for women (adjusted hazards ratio (AHR) = 14.24, 95%CI = 10.99, 18.46) than for men (AHR = 9.91 , 95%CI = 7.75, 12.67). Overall, AMI cases were also more likely to be hosp italized subsequently than the hospitalized controls (referent; adjusted od ds ratio (AOR) = 1.47, 95%CI = 1.17, 1,85), although in the stratified anal ysis this association held for men (AOR = 1.73, 95%CI = 1.25, 2.41) but not for women (AOR = 1.25, 95%CI =.90, 1.73). Among those subsequently hospita lized, both women and men AMI cases consumed more hospital resources than t he hospitalized controls, and there were gender differences suggesting that the effects on total charges and length of stay were greater for women tha n for men with AMI. Finally, although the AMI cases had greater adjusted me an increases in the number of instrumental activities of daily living limit ations and lower body limitations than the nonhospitalized controls, they w ere no worse off than the hospitalized controls, and there were no gender d ifferences in those effects. CONCLUSION: Relative to the appropriate comparison groups, hospitalization for an AMI increases the risk of death and the total costs and lengths of s tay of subsequent hospitalizations for women more than for men. Therefore, increased primary prevention, diagnosis, and treatment efforts should be di rected toward women.