Abstract
BackgroundArterial diseases represent a severe public health problem in the 21st century. Although men have a higher overall prevalence, reports have suggested that women may exhibit atypical manifestations, be asymptomatic, and have hormonal peculiarities, resulting in worse outcomes and severe emergencies, such as acute limb ischemia (ALI).ObjectivesTo analyze the morbidity and mortality profile of ALI emergencies in Brazil between 2008 and 2019.MethodsAn ecological study was carried out with secondary data from SIH/SUS, using ICD-10 code I.74 The proportions of emergency hospital admissions and in-hospital mortality rates (HMR) by gender, ethnicity, and age were extracted from the overall figures. P<0.05 was considered significant.ResultsFrom 2008 to 2019, there were 195,567 urgent hospitalizations due to ALI in Brazil, 111,145 (56.8%) of which were of men. Women had a higher HMR (112:1,000 hospitalizations) than men (85:1,000 hospitalizations) (p<0.05), and a higher chance of death (OR=1.36; p<0.05). Furthermore, mean survival was significantly higher among men (8,483/year versus 6,254/year; p<0.05). Stratified by ethnicity, women who self-identified as white (OR=1.44; p<0.05), black (OR=1.33; p<0.05), and brown (RR=1.25; p <0.05) had greater chances of death than men in the same ethnicity categories. Moreover, women over the age of 50 years had a higher chance of death, with a progressive increment in risk as age increased.ConclusionsThere was a trend to worse prognosis in ALI emergencies associated with women, especially in older groups. The literature shows that the reasons for these differences are still poorly investigated and more robust studies of this relevant disease in the area of vascular surgery are encouraged.
Highlights
IntroductionMen were believed to have higher overall prevalence of cardiovascular diseases compared to women.[8] recent studies have been assessing gender-differences for several arterial disorders and new premises have been posing female sex as an important risk factor for worse outcomes.[2,3,9,10] there is a lack of studies assessing gender and peripheral arterial obstruction emergencies in Brazil
Acute thrombosis of an artery occurs most frequently at the site of an atherosclerotic plaque due to peripheral arterial disease (PAD), which is the designation of preference for partial or complete occlusions of the abdominal aorta or limb arteries.[1,2,3,4,5]
Given the public health relevance of atherosclerotic arteriopathy and the scarcity of studies comparing sex-related outcomes and peripheral arterial disease in Brazil, this study aimed to evaluate gender disparities in hospital morbidity and mortality in emergency admissions for arterial thromboses and embolisms in the country’s Unified Health System (Sistema Único de Saúde – SUS). This population-based, retrospective, and observational study, carried out with secondary data from a government database, evaluated gender as a specific risk factor for in-hospital morbidity and mortality related to emergencies due to arterial thromboses and embolisms in Brazil
Summary
Men were believed to have higher overall prevalence of cardiovascular diseases compared to women.[8] recent studies have been assessing gender-differences for several arterial disorders and new premises have been posing female sex as an important risk factor for worse outcomes.[2,3,9,10] there is a lack of studies assessing gender and peripheral arterial obstruction emergencies in Brazil. There is concern about the relevant association between female sex hormones, the susceptibility to arterial diseases, and the differences in the periods of peaks and nadir of hormone levels during a lifetime, such as menacme and menopause.[11,12] The mean age for menopause in Brazil is 51.2 years[13] and postmenopausal women are at greater risk of PAD and ALI.[11]. The literature shows that the reasons for these differences are still poorly investigated and more robust studies of this relevant disease in the area of vascular surgery are encouraged
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