{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T11:19:43Z","timestamp":1789643983523,"version":"4.0.0"},"reference-count":70,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Cardiovascular Quality and Outcomes"],"published-print":{"date-parts":[[2024,3]]},"abstract":"<jats:sec>\n            <jats:title>BACKGROUND:<\/jats:title>\n            <jats:p>Sex differences in acute myocardial infarction treatment and outcomes are well documented, but it is unclear whether differences are consistent across countries. The objective of this study was to investigate the epidemiology, use of interventional procedures, and outcomes for older females and males hospitalized with ST-segment\u2013elevation myocardial infarction (STEMI) and non\u2013ST-segment\u2013elevation myocardial infarction (NSTEMI) in 6 diverse countries.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>METHODS:<\/jats:title>\n            <jats:p>We conducted a serial cross-sectional cohort study of 1\u2005508\u2005205 adults aged \u226566 years hospitalized with STEMI and NSTEMI between 2011 and 2018 in the United States, Canada, England, the Netherlands, Taiwan, and Israel using administrative data. We compared females and males within each country with respect to age-standardized hospitalization rates, rates of cardiac catheterization, percutaneous coronary intervention, and coronary artery bypass graft surgery within 90 days of hospitalization, and 30-day age- and comorbidity-adjusted mortality.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>RESULTS:<\/jats:title>\n            <jats:p>Hospitalization rates for STEMI and NSTEMI decreased between 2011 and 2018 in all countries, although the hospitalization rate ratio (rate in males\/rate in females) increased in virtually all countries (eg, US STEMI ratio, 1.58:1 in 2011 and 1.73:1 in 2018; Israel NSTEMI ratio, 1.71:1 in 2011 and 2.11:1 in 2018). Rates of cardiac catheterization, percutaneous coronary intervention, and coronary artery bypass graft surgery were lower for females than males for STEMI in all countries and years (eg, US cardiac catheterization in 2018, 88.6% for females versus 91.5% for males; Israel percutaneous coronary intervention in 2018, 76.7% for females versus 84.8% for males) with similar findings for NSTEMI. Adjusted mortality for STEMI in 2018 was higher for females than males in 5 countries (the United States, Canada, the Netherlands, Israel, and Taiwan) but lower for females than males in 5 countries for NSTEMI.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>CONCLUSIONS:<\/jats:title>\n            <jats:p>We observed a larger decline in acute myocardial infarction hospitalizations for females than males between 2011 and 2018. Females were less likely to receive cardiac interventions and had higher mortality after STEMI. Sex disparities seem to transcend borders, raising questions about the underlying causes and remedies.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/circoutcomes.123.010144","type":"journal-article","created":{"date-parts":[[2024,2,8]],"date-time":"2024-02-08T10:00:47Z","timestamp":1707386447000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":18,"title":["Sex-Based Disparities in Acute Myocardial Infarction Treatment Patterns and Outcomes in Older Adults Hospitalized Across 6 High-Income Countries: An Analysis From the International Health Systems Research Collaborative"],"prefix":"10.1161","volume":"17","author":[{"given":"Hannah","family":"Lu","sequence":"first","affiliation":[{"name":"John Sealy School of Medicine, University of Texas Medical Branch, Galveston, TX (H.L., P.C.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0366-3929","authenticated-orcid":true,"given":"Laura A.","family":"Hatfield","sequence":"additional","affiliation":[{"name":"Department of Health Care Policy, Harvard Medical School, Boston, MA (L.A.H., C.F., G.W., B.E.L.)."},{"name":"Division of General Medicine, Beth Israel Deaconess Medical Center (L.A.H., B.E.L.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6695-5825","authenticated-orcid":true,"given":"Saeed","family":"Al-Azazi","sequence":"additional","affiliation":[{"name":"George &amp; Fay Yee Centre for Healthcare Innovation (S.A.-A., L.M.L.), University of Manitoba, Winnipeg, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7749-3091","authenticated-orcid":true,"given":"Pieter","family":"Bakx","sequence":"additional","affiliation":[{"name":"Erasmus School of Health Policy &amp; Management, Erasmus University, Rotterdam, the Netherlands (P.B., R.H., C.A.U.G.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8741-3411","authenticated-orcid":true,"given":"Amitava","family":"Banerjee","sequence":"additional","affiliation":[{"name":"Institute of Health Informatics, University College London, United Kingdom (A.B., L.P.)."},{"name":"Consultant in Cardiology, University College London Hospitals, United Kingdom (A.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6926-8505","authenticated-orcid":true,"given":"Nitzan","family":"Burrack","sequence":"additional","affiliation":[{"name":"Clinical Research Center, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beersheba, Israel (N.B., M.G., V.N.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu-Chin","family":"Chen","sequence":"additional","affiliation":[{"name":"Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei, Taiwan (Y.-C.C., N.H.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christina","family":"Fu","sequence":"additional","affiliation":[{"name":"Department of Health Care Policy, Harvard Medical School, Boston, MA (L.A.H., C.F., G.W., B.E.L.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michal","family":"Gordon","sequence":"additional","affiliation":[{"name":"Clinical Research Center, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beersheba, Israel (N.B., M.G., V.N.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5324-6659","authenticated-orcid":true,"given":"Renaud","family":"Heine","sequence":"additional","affiliation":[{"name":"Erasmus School of Health Policy &amp; Management, Erasmus University, Rotterdam, the Netherlands (P.B., R.H., C.A.U.G.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6629-1176","authenticated-orcid":true,"given":"Nicole","family":"Huang","sequence":"additional","affiliation":[{"name":"Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei, Taiwan (Y.-C.C., N.H.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6840-8051","authenticated-orcid":true,"given":"Dennis T.","family":"Ko","sequence":"additional","affiliation":[{"name":"ICES, Toronto, ON (D.T.K., F.Q., T.A.S., P.C.)."},{"name":"Schulich Heart Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada (D.T.K.)."},{"name":"Faculty of Medicine (D.T.K., P.C.), University of Toronto, ON, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa M.","family":"Lix","sequence":"additional","affiliation":[{"name":"George &amp; Fay Yee Centre for Healthcare Innovation (S.A.-A., L.M.L.), University of Manitoba, Winnipeg, Canada."},{"name":"Department of Community Health Sciences (L.M.L.), University of Manitoba, Winnipeg, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8706-9622","authenticated-orcid":true,"given":"Victor","family":"Novack","sequence":"additional","affiliation":[{"name":"Clinical Research Center, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beersheba, Israel (N.B., M.G., V.N.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9374-9691","authenticated-orcid":true,"given":"Laura","family":"Pasea","sequence":"additional","affiliation":[{"name":"Institute of Health Informatics, University College London, United Kingdom (A.B., L.P.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9882-7564","authenticated-orcid":true,"given":"Feng","family":"Qiu","sequence":"additional","affiliation":[{"name":"ICES, Toronto, ON (D.T.K., F.Q., T.A.S., P.C.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9283-8764","authenticated-orcid":true,"given":"Therese A.","family":"Stukel","sequence":"additional","affiliation":[{"name":"ICES, Toronto, ON (D.T.K., F.Q., T.A.S., P.C.)."},{"name":"Institute for Health Management Policy and Evaluation (T.A.S.), University of Toronto, ON, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5808-302X","authenticated-orcid":true,"given":"Carin A.","family":"Uyl-de Groot","sequence":"additional","affiliation":[{"name":"Erasmus School of Health Policy &amp; Management, Erasmus University, Rotterdam, the Netherlands (P.B., R.H., C.A.U.G.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1220-8090","authenticated-orcid":true,"given":"Gabe","family":"Weinreb","sequence":"additional","affiliation":[{"name":"Department of Health Care Policy, Harvard Medical School, Boston, MA (L.A.H., C.F., G.W., B.E.L.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4912-0647","authenticated-orcid":true,"given":"Bruce E.","family":"Landon","sequence":"additional","affiliation":[{"name":"Department of Health Care Policy, Harvard Medical School, Boston, MA (L.A.H., C.F., G.W., B.E.L.)."},{"name":"Division of General Medicine, Beth Israel Deaconess Medical Center (L.A.H., B.E.L.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1910-346X","authenticated-orcid":true,"given":"Peter","family":"Cram","sequence":"additional","affiliation":[{"name":"John Sealy School of Medicine, University of Texas Medical Branch, Galveston, TX (H.L., P.C.)."},{"name":"ICES, Toronto, ON (D.T.K., F.Q., T.A.S., P.C.)."},{"name":"Faculty of Medicine (D.T.K., P.C.), University of Toronto, ON, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2020.11.010"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.cir.91.6.1861"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCOUTCOMES.114.001612"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2017-020211"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2012.199"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2008.07.028"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12916-014-0190-6"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.114.009480"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2022.08.036"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1136\/heartjnl-2021-319566"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2016.04.009"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2458-12-617"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2017.06.014"},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10680-014-9329-6"},{"key":"e_1_3_3_16_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12875-016-0440-0"},{"key":"e_1_3_3_17_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000617"},{"key":"e_1_3_3_18_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehx393"},{"key":"e_1_3_3_19_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj-2021-069164"},{"key":"e_1_3_3_20_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2023.1699"},{"key":"e_1_3_3_21_2","doi-asserted-by":"publisher","DOI":"10.1186\/1472-6963-13-340"},{"key":"e_1_3_3_22_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.mlr.0000182534.19832.83"},{"key":"e_1_3_3_23_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmjebm-2019-111264"},{"key":"e_1_3_3_24_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.118.037137"},{"key":"e_1_3_3_25_2","doi-asserted-by":"publisher","DOI":"10.1097\/BRS.0000000000003083"},{"key":"e_1_3_3_26_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2019.12.026"},{"key":"e_1_3_3_27_2","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.119.013542"},{"key":"e_1_3_3_28_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2019.1938"},{"key":"e_1_3_3_29_2","doi-asserted-by":"publisher","DOI":"10.1177\/2047487318780033"},{"key":"e_1_3_3_30_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehx097"},{"key":"e_1_3_3_31_2","doi-asserted-by":"publisher","DOI":"10.1093\/geronb\/gbac032"},{"key":"e_1_3_3_32_2","doi-asserted-by":"publisher","DOI":"10.1016\/s0140-6736(21)01169-7"},{"key":"e_1_3_3_33_2","doi-asserted-by":"publisher","DOI":"10.1016\/s0277-9536(99)00390-1"},{"key":"e_1_3_3_34_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2019-036418"},{"key":"e_1_3_3_35_2","unstructured":"OECD. Health at a Glance 2021. 2021. Accessed April 16 2022. https:\/\/www.oecd-ilibrary.org\/content\/publication\/ae3016b9-en"},{"key":"e_1_3_3_36_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2004.11.055"},{"key":"e_1_3_3_37_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(20)30543-2"},{"key":"e_1_3_3_38_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajem.2018.05.005"},{"key":"e_1_3_3_39_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.rec.2021.05.006"},{"key":"e_1_3_3_40_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.cjca.2018.11.031"},{"key":"e_1_3_3_41_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2021.09.006"},{"key":"e_1_3_3_42_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.cjca.2022.06.023"},{"key":"e_1_3_3_43_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2015.08.865"},{"key":"e_1_3_3_44_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.hlc.2020.06.025"},{"key":"e_1_3_3_45_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2018.0514"},{"key":"e_1_3_3_46_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2022.12.025"},{"key":"e_1_3_3_47_2","doi-asserted-by":"publisher","DOI":"10.1136\/openhrt-2018-000868"},{"key":"e_1_3_3_48_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2016.09.052"},{"key":"e_1_3_3_49_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.111.086892"},{"key":"e_1_3_3_50_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2010.04.017"},{"key":"e_1_3_3_51_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCOUTCOMES.119.006037"},{"key":"e_1_3_3_52_2","doi-asserted-by":"publisher","DOI":"10.3390\/jcdd9080239"},{"key":"e_1_3_3_53_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2018.1152"},{"key":"e_1_3_3_54_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacr.2017.04.005"},{"key":"e_1_3_3_55_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMhpr1804089"},{"key":"e_1_3_3_56_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2013.10789"},{"key":"e_1_3_3_57_2","doi-asserted-by":"publisher","DOI":"10.1001\/archinternmed.2010.227"},{"key":"e_1_3_3_58_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCOUTCOMES.120.006570"},{"key":"e_1_3_3_59_2","doi-asserted-by":"publisher","DOI":"10.1067\/mhj.2000.109222"},{"key":"e_1_3_3_60_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.cjco.2021.04.012"},{"key":"e_1_3_3_61_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.f2350"},{"key":"e_1_3_3_62_2","doi-asserted-by":"publisher","DOI":"10.1093\/ije\/dyv098"},{"key":"e_1_3_3_63_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2017-019217"},{"key":"e_1_3_3_64_2","volume-title":"Netherlands: Health System Review","author":"World Health Organization. Regional Office for European Observatory on Health Systems and Policies","year":"2016","unstructured":"World Health Organization. Regional Office for European Observatory on Health Systems and Policies, Kroneman, M, Boerma, W, van den Berg, M, Groenewegen, P, de Jong, J, van Ginneken, E. Netherlands: Health System Review. World Health Organization. Regional Office for Europe; 2016."},{"key":"e_1_3_3_65_2","doi-asserted-by":"publisher","DOI":"10.2196\/10734"},{"key":"e_1_3_3_66_2","doi-asserted-by":"publisher","DOI":"10.2147\/CLEP.S196293"},{"key":"e_1_3_3_67_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2018.08.047"},{"key":"e_1_3_3_68_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00198-003-1403-6"},{"key":"e_1_3_3_69_2","doi-asserted-by":"publisher","DOI":"10.1177\/0962280206070621"},{"key":"e_1_3_3_70_2","doi-asserted-by":"publisher","DOI":"10.1002\/(sici)1097-0258(19970415)16:7<791::aid-sim500>3.0.co;2-#"},{"key":"e_1_3_3_71_2","doi-asserted-by":"publisher","DOI":"10.1002\/sim.4780141909"}],"container-title":["Circulation: Cardiovascular Quality and Outcomes"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/CIRCOUTCOMES.123.010144","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,5,29]],"date-time":"2025-05-29T21:14:19Z","timestamp":1748553259000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/CIRCOUTCOMES.123.010144"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,3]]},"references-count":70,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2024,3]]}},"alternative-id":["10.1161\/CIRCOUTCOMES.123.010144"],"URL":"https:\/\/doi.org\/10.1161\/circoutcomes.123.010144","relation":{},"ISSN":["1941-7713","1941-7705"],"issn-type":[{"value":"1941-7713","type":"print"},{"value":"1941-7705","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,3]]},"assertion":[{"value":"2023-04-15","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-10-27","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-02-08","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}