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To determine the effects of female gender on long-term survival and subsequent coronary heart disease events in a population developing first clinical manifestations of coronary artery disease.Follow-up of all Rochester, Minn, residents first diagnosed with either angina pectoris or myocardial infarction/sudden unexpected death between January 1, 1960, and December 31, 1979.Patients with angina pectoris were followed up through 1982 for survival and time to initial myocardial infarction/cardiac death. Patients with myocardial infarction were followed up through 1982 for survival and time to recurrent myocardial infarction/cardiac death.Angina pectoris was the initial diagnosis for 529 women and 504 men. Myocardial infarction or sudden unexpected death was the initial diagnosis for 611 women and 997 men. The average age of patients diagnosed with angina pectoris was 67.0 years (SE, 0.5 years) for women and 60.0 years (SE, 0.5 years) for men. The average age of patients diagnosed with myocardial infarction/sudden unexpected death was 71.9 years (SE, 0.5 years) for women and 62.0 years (SE, 0.4 years) for men. Women presenting with angina pectoris survived significantly longer and had a lower incidence of subsequent myocardial infarction/cardiac death compared with men of similar age (P < .01). When rates of myocardial infarction and sudden unexpected death were combined to assess all cardiac endpoints with objective criteria ("hard" endpoints), women presenting with myocardial infarction/sudden unexpected death had survival rates and risk of subsequent myocardial infarction/coronary death that were similar to men of the same age. When survival following myocardial infarction was analyzed separately, survival also did not vary by gender.In this population, women with angina pectoris as an initial diagnosis, but not those with myocardial infarction or sudden unexpected death, have longer survival and lower risk of subsequent myocardial infarction/cardiac death than do men with the same presentation and of a similar age.
Objective To study the incidence of de novo multimorbidity across all ages in a geographically defined population with an emphasis on sex and ethnic differences. Design Historical cohort study. Setting All persons residing in Olmsted County, Minnesota, USA on 1 January 2000 who had granted permission for their records to be used for research (n=123 716). Participants We used the Rochester Epidemiology Project medical records-linkage system to identify all of the county residents. We identified and removed from the cohort all persons who had developed multimorbidity before 1 January 2000 (baseline date), and we followed the cohort over 14 years (1 January 2000 through 31 December 2013). Main outcome measures Incident multimorbidity was defined as the development of the second of 2 conditions (dyads) from among the 20 chronic conditions selected by the US Department of Health and Human Services. We also studied the incidence of the third of 3 conditions (triads) from among the 20 chronic conditions. Results The incidence of multimorbidity increased steeply with older age; however, the number of people with incident multimorbidity was substantially greater in people younger than 65 years compared to people age 65 years or older (28 378 vs 6214). The overall risk was similar in men and women; however, the combinations of conditions (dyads and triads) differed extensively by age and by sex. Compared to Whites, the incidence of multimorbidity was higher in Blacks and lower in Asians. Conclusions The risk of developing de novo multimorbidity increases steeply with older age, varies by ethnicity and is similar in men and women overall. However, as expected, the combinations of conditions vary extensively by age and sex. These data represent an important first step toward identifying the causes and the consequences of multimorbidity.
OREGON, Massachusetts, Vermont, New Jersey, Hawaii, and now Minnesota have adopted legislation with broad implications for health care system reform. Each of these reform packages will be examined by other states and the federal government as they attempt to deal with health care system reform policies and issues. Blendon et al 1 recently published a set of characteristics that they felt should be included in any major health care system reform plan (Table 1). The article by Blendon et al was accompanied by an editorial in which Lundberg 2 presented a set of criteria for analyzing the reform packages (Table 2). The criteria of Blendon et al resemble process analysis, whereas Lundberg's criteria involve outcome analysis. Minnesota's new MinnesotaCare (formerly HealthRight) will be analyzed herein with reference to both sets of criteria. (Due to conflict with a trademark in California, the name Health-Right was changed to MinnesotaCare. But that name
The objective of Integrated Care Pathways for Airway Diseases (AIRWAYS-ICPs) is to launch a collaboration to develop multi-sectoral care pathways for chronic respiratory diseases in European countries and regions.AIRWAYS-ICPs has strategic relevance to the European Union Health Strategy and will add value to existing public health knowledge by: 1) proposing a common framework of care pathways for chronic respiratory diseases, which will facilitate comparability and trans-national initiatives; 2) informing cost-effective policy development, strengthening in particular those on smoking and environmental exposure; 3) aiding risk stratification in chronic disease patients, using a common strategy; 4) having a significant impact on the health of citizens in the short term (reduction of morbidity, improvement of education in children and of work in adults) and in the long-term (healthy ageing); 5) proposing a common simulation tool to assist physicians; and 6) ultimately reducing the healthcare burden (emergency visits, avoidable hospitalisations, disability and costs) while improving quality of life.In the longer term, the incidence of disease may be reduced by innovative prevention strategies.AIRWAYS-ICPs was initiated by Area 5 of the Action Plan B3 of the European Innovation Partnership on Active and Healthy Ageing.All stakeholders are involved (health and social care, patients, and policy makers).@ERSpublications AIRWAYS-ICPs: launch of a collaboration to develop multi-sectoral integrated care pathways for respiratory disease
