Impact of Sex-and Gender-Related Factors on Length of Stay Following Non–ST-Segment–Elevation Myocardial Infarction: A Multicountry Analysis

Abstract

BACKGROUND: Gender-related factors are psycho-socio-cultural characteristics and are associated with adverse clinical outcomes in acute myocardial infarction, independent of sex. Whether sex-and gender-related factors contribute to the substantial heterogeneity in hospital length of stay (LOS) among patients with non–ST-segment–elevation myocardial infarction remains unknown. METHODS AND RESULTS: This observational cohort study combined and analyzed data from the GENESIS-PRAXY (Gender and Sex Determinants of Cardiovascular Disease: From Bench to Beyond Premature Acute Coronary Syndrome study), EVA (Endocrine Vascular Disease Approach study), and VIRGO (Variation in Recovery: Role of Gender on Outcomes of Young AMI [Acute Myocardial Infarction] Patients study) cohorts of adults hospitalized across Canada, the United States, Switzerland, Italy, Spain, and Australia for non–ST-segment–elevation myocardial infarction. In total, 5219 participants were assessed for eligibility. Sixtythree patients were excluded for missing LOS, and 2938 were excluded because of no non–ST-segment–elevation myocardial infarction diagnosis. In total, 2218 participants were analyzed (66% women; mean±SD age, 48.5±7.9 years; 67.8% in the United States). Individuals with longer LOS (51%) were more likely to be White race, were more likely to have diabetes, hypertension, and a lower income, and were less likely to be employed and have completed secondary education. No univariate association between sex and LOS was observed. In the adjusted multivariable model, age (0.62 d/10 y; P<0.001), unemployment (0.63 days; P=0.01), and some of countries included relative to Canada (Italy, 4.1 days; Spain, 1.7 days; and the United States, −1.0 days; all P<0.001) were independently associated with longer LOS. Medical history mediated the effect of employment on LOS. No interaction between sex and employment was observed. Longer LOS was associated with increased 12-month all-cause mortality. CONCLUSIONS: Older age, unemployment, and country of hospitalization were independent predictors of LOS, regardless of sex. Individuals employed with non–ST-segment–elevation myocardial infarction were more likely to experience shorter LOS. Sociocultural factors represent a potential target for improvement in health care expenditure and resource allocation.