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      Life expectancy and years of potential life lost after acute myocardial infarction by sex and race: a cohort-based study of Medicare beneficiaries

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          Abstract

          Background

          Most studies of sex and race differences after acute myocardial infarction (AMI) have not taken into account differences in life expectancy in the general population. Years of potential life lost (YPLLs) is a metric that takes into account the burden of disease and can be compared by sex and race.

          Objectives

          We sought to determine sex and race differences in long-term survival after AMI using life expectancy and YPLL to account for differences in population-based life expectancy.

          Methods

          Using data from the Cooperative Cardiovascular Project, a prospective cohort study of Medicare beneficiaries hospitalized for AMI between 1994–1995 (n = 146,743), we 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% (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

          Women and black patients lost more years of life after AMI, on average, than men and white patients, an effect that was not explained in women by clinical or treatment differences.

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          Author and article information

          Journal
          8301365
          4429
          J Am Coll Cardiol
          J. Am. Coll. Cardiol.
          Journal of the American College of Cardiology
          0735-1097
          1558-3597
          17 March 2017
          11 August 2015
          05 June 2017
          : 66
          : 6
          : 645-655
          Affiliations
          [1 ]Yale School of Medicine and Yale School of Public Health, New Haven, Connecticut
          [2 ]Department of Health Care Policy, Harvard Medical School and Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
          [3 ]Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut
          [4 ]Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut
          [5 ]Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven CT; Robert Wood Johnson Clinical Scholars Program, Department of Medicine; and the Section of Health Policy and Administration, School of Public Health, Yale University School of Medicine, New Haven, Connecticut
          Author notes
          Address for Correspondence: Harlan M. Krumholz, MD, SM, Department of Internal Medicine, Yale University School of Medicine, 1 Church St. Suite 200, New Haven, CT 06510, Telephone: 203-764-5700, Fax: 203-764-5653, harlan.krumholz@ 123456yale.edu
          Article
          PMC5459400 PMC5459400 5459400 nihpa849282
          10.1016/j.jacc.2015.06.022
          5459400
          26248991
          be42b964-af7e-4130-a5de-755de01c7a77
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          Article

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