Sex and race differences in short-term prognosis after acute coronary hear, disease events: The Atherosclerosis Risk In Communities (ARIC) study

Background Case fatality after myocardial infarction (MI) among patients ad mitted to the hospital may differ between men and women and blacks and whit es. Furthermore, a different pattern of sex and race differences in case fa tality may occur when coronary deaths outside the hospital are included in the analysis. The ARIC study provides community-based data to examine 28-da y case fatality rates after coronary heart disease (CHD) events. Method and Results Surveillance of out-of-hospital CHD deaths and hospitali zed MI was conducted in 4 U.S. communities from 1987 to 1993. Hospital disc harges and death certificates were sampled, medical records abstracted, and interviews conducted with witnesses of out-of-hospital deaths. MI and out- of-hospital death classifications followed a standard algorithm. linkage of hospitalized Mis to fatality within 28 days ensured complete ascertainment of case fatality rate. Comorbidities and complications during hospital sta y were compared to assess possible explanatory factors for differences in c ase fatality. Overall, age-adjusted 28-day case fatality (MI plus CHD) was higher in black men compared with white men (odds ratio 1.78, 95% confidenc e interval 1.4-2.2) and in black women compared with white women (odds rati o 1.5, 95% confidence interval 1.2-2.0). Although men had higher overall ca se fatality rates than did women, this difference was not statistically sig nificant. After a hospitalized MI, 28-day case fatality rate was not statis tically significantly different between men compared with women or blacks c ompared with whites. Conclusion Race and sex differences in case fatality after hospitalized MI were not evident in these data, although when out-of-hospital deaths were i ncluded, men and blacks were more likely than women and whites to die withi n 28 days of an acute cardiac event. A majority of deaths occurred before h ospital admission, and additional study of possible reasons for these diffe rences should be a priority.