Key result
Women with aortic dissection had a higher 30-day mortality than men (18.1% vs 14.1%; adjusted OR 1.19, 95% CI 1.10-1.29), with the difference observed mainly in patients not treated with surgery.
Why the study?
Although sex differences in epidemiological features of aortic dissection are known, whether sex differences exist in the associations of comorbidities and risk factors with aortic dissection was unclear.
Are there sex differences in the incidence, 30-day mortality, and risk factors associated with aortic dissection?
Case-Control (n=23,420)
Yes
Are there sex differences in the incidence, 30-day mortality, and risk factors associated with aortic dissection?
Women with aortic dissection experience higher 30-day mortality than men, particularly when managed non-surgically, and show stronger associations with risk factors such as atrial fibrillation and chronic kidney disease.
May warrant attention to non-surgical aortic dissection management in women; extends limited evidence on sex disparities but leaves practice implications open.
Background Although sex differences in the epidemiological features of aortic dissection (AD) are known, whether there were sex differences in the associations of comorbidities and risk factors with AD is unclear. We evaluated the temporal trends and risk factors of AD by sex. Methods and Results Using claims data from a universal health insurance program linked to the National Death Registry in Taiwan, we identified 16 368 men and 7052 women with newly diagnosed AD from 2005 to 2018. In the case-control analysis, a matched control group without AD was selected for men and women separately. Conditional logistic regression was used to evaluate risk factors of AD and sex differences. Over the 14 years, the annual incidence of diagnosed AD was 12.69 and 5.34 per 100 000 in men and women, respectively. The 30-day mortality was greater in women than in men (18.1% versus 14.1%; adjusted odds ratio [95% CI], 1.19 [1.10-1.29]), and the sex difference was observed mainly in patients not treated with surgery. The 30-day mortality declined over time in male patients undergoing surgical treatments, but no significantly temporal change was found in other patient groups stratified by sex and surgery. After multivariable adjustments, atrial fibrillation, chronic kidney disease, and coronary artery bypass graft surgery were associated with a greater increase in the odds of AD occurrence in women than in men. Conclusions Greater 30-day mortality and stronger associations of atrial fibrillation, chronic kidney disease, and coronary artery bypass graft surgery with AD in women than in men require further attention.
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Chang et al. (2023) conducted a case-control in Aortic Dissection (n=23,420). Female sex vs. Male sex was evaluated on 30-day mortality (adjusted OR 1.19, 95% CI 1.10-1.29). Women with aortic dissection had a higher 30-day mortality than men (18.1% vs 14.1%; adjusted OR 1.19, 95% CI 1.10-1.29), with the difference observed mainly in patients not treated with surgery.
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