{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T04:47:12Z","timestamp":1792126032222,"version":"4.4.0"},"reference-count":34,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2026,1,6]]},"abstract":"<jats:sec xml:lang=\"en\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p xml:lang=\"en\">While prior studies have assessed sex disparities in ischemic heart disease (IHD) outcomes in the United States, little is known about how these differences vary across states.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p xml:lang=\"en\">\n                      We analyzed GBD (Global Burden of Disease) data from 2011 to 2021 for all 50 US states. Sex\u2010specific IHD age\u2010standardized mortality rates and IHD age\u2010standardized prevalence rates were used to calculate the mortality\u2010to\u2010prevalence ratios per 100\u2009000 inhabitants per year, enabling comparison of death rates relative to the population at risk. Hawaii, the state with the lowest age\u2010standardized prevalence rate and age\u2010standardized mortality rate in both sexes, served as the reference for\n                      <jats:italic toggle=\"no\">Z<\/jats:italic>\n                      score analyses, with 99% (\n                      <jats:italic toggle=\"no\">Z<\/jats:italic>\n                      &gt;2.58) or 95% (\n                      <jats:italic toggle=\"no\">Z<\/jats:italic>\n                      &gt;1.96) confidence thresholds.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p xml:lang=\"en\">\n                      In 2011, 30 states had significantly higher mortality\u2010to\u2010prevalence ratios in women than men (\n                      <jats:italic toggle=\"no\">Z<\/jats:italic>\n                      &gt;2.58), indicating an elevated mortality rate in women with IHD. By 2021, only Arkansas (6.7% [95% uncertainty interval, 4.6\u20139.3]) and Mississippi (7.1% [95% uncertainty interval, 4.8\u20139.7]) exceeded this threshold, while 11 additional states, mainly in the South, retained moderate disparities (\n                      <jats:italic toggle=\"no\">Z<\/jats:italic>\n                      &gt;1.96). Higher mortality\u2010to\u2010prevalence ratios were inversely associated with state gross domestic product per capita. High body mass index, processed meat intake, low fiber, and low vegetable intake emerged as the most significant contributors (\n                      <jats:italic toggle=\"no\">Z<\/jats:italic>\n                      &gt;1.96, 95% confidence level) to excess IHD death in women but not men.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p xml:lang=\"en\">Despite an overall decline, sex disparities in IHD death persist, with Arkansas and Mississippi continuing to bear the highest burden. These disparities are largely driven by overweight\/obesity and dietary risk factors, warranting targeted, state\u2010level interventions.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/jaha.125.043914","type":"journal-article","created":{"date-parts":[[2025,11,3]],"date-time":"2025-11-03T15:01:50Z","timestamp":1762182110000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":4,"title":["Sex Disparities in Ischemic Heart Disease Death Across the United States: The Southern Burden of Excess Body Weight and Diet"],"prefix":"10.1161","volume":"15","author":[{"given":"Tania","family":"Rahaman","sequence":"first","affiliation":[{"name":"University of Bologna","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8102-3324","authenticated-orcid":false,"given":"Edina","family":"Cenko","sequence":"additional","affiliation":[{"name":"University of Bologna","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5652-2401","authenticated-orcid":false,"given":"Olivia","family":"Manfrini","sequence":"additional","affiliation":[{"name":"University of Bologna","place":["Italy"]},{"name":"IRCCS Azienda Ospedaliero\u2010Universitaria di Bologna Sant\u2019Orsola Hospital","place":["Bologna, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5782-9926","authenticated-orcid":false,"given":"Angela","family":"Maas","sequence":"additional","affiliation":[{"name":"Radboud University Medical Center","place":["Nijmegen, Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1389-0597","authenticated-orcid":false,"given":"Maria","family":"Bergami","sequence":"additional","affiliation":[{"name":"University of Bologna","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4732-382X","authenticated-orcid":false,"given":"Chris P.","family":"Gale","sequence":"additional","affiliation":[{"name":"University of Leeds","place":["Leeds, United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0735-9756","authenticated-orcid":false,"given":"Martha","family":"Gulati","sequence":"additional","affiliation":[{"name":"Cedars\u2010Sinai Medical Center","place":["Los Angeles, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6819-6818","authenticated-orcid":false,"given":"Raffaele","family":"Bugiardini","sequence":"additional","affiliation":[{"name":"University of Bologna","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2018.0514"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCOUTCOMES.116.003443"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.118.037137"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(17)30786-9"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(24)01446-6"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacadv.2024.101252"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(24)00769-4"},{"key":"e_1_3_2_9_2","unstructured":"Institute for Health Metrics and Evaluation . 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