Uncovering Gender Disparities in Secondary Care for Major Adverse Cardiovascular Events (MACE): Insights From the Hospital Episodes Statistics (HES) Database
Author(s)
Fiona C. Glen, PhD1, Bradley Chiuri, BSc1, Stephen Boult, BSc1, Luca Le Treust, MSc1, Bethany Levick, PhD1, Chris Rolfe, NA1, Philippa Rowan, BSc1, Fatemeh Saberi Hosnijeh, PhD MD2, Shea O'Connell, PhD1.
1OPEN Health, London, United Kingdom, 2OPEN Health, Rotterdam, Netherlands.
1OPEN Health, London, United Kingdom, 2OPEN Health, Rotterdam, Netherlands.
OBJECTIVES: There is growing recognition of gender disparities in cardiovascular (CV) care, emphasising the need for targeted research to inform more equitable healthcare. This study explores gender-related differences in the demographics, secondary care management, and outcomes of adults experiencing major adverse CV events (MACE) in England.
METHODS: Adults aged ≥18 with a hospital attendance for MACE (non-fatal myocardial infarction [NMI], non-fatal stroke [NFS], or CV-death) between 2022-2024 were identified from Hospital Episode Statistics (HES) and linked Office of National Statistics (ONS) mortality data. NFS and NMI events were identified by primary ICD-10 diagnosis codes with survival ≥30 days, while CV-death was defined as death with a CV-related primary cause in ONS data. Study endpoints - including baseline demographics, mortality, and CV-related attendances per person-years before (since 2015) and after (to end of 2024) first MACE / index - were compared between men and women based on person-stated gender in HES.
RESULTS: More men (405,959) than women (291,008) presented with MACE between 2022-24 (mean age of women / men at first MACE: 77 / 71 years; p<0.001). Yet, a higher proportion of women (37%, 108,499) than men (31%, 125,660) had CV-death as first MACE. NMI was more frequent in men (36% [146,998] vs.24% [70,501]), while NFS was more frequent in women (38% [112,008] vs.33% [133,306];overall p<0.001). More men had a history of revascularisation (8% [31,498] vs 3% [9,194;p<0.001] while more women had prior transient ischaemic attacks (3% [7,411] vs 2% [7693];p<0.001). Pre-MACE A&E attendances were 12% lower in men than women (IRR:0.88 [95%CI: 0.87,0.89]; p<0.001). Women had higher subsequent CV-related mortality (p<0.001) with a 3-year CV-related death rate (cumulative incidence) of 16% vs. 12% in men.
CONCLUSIONS: Gender differences exist in MACE incidence and outcomes: men have more events, yet women have higher mortality and prior emergency-care use, potentially suggesting suboptimal routes to CV care.
METHODS: Adults aged ≥18 with a hospital attendance for MACE (non-fatal myocardial infarction [NMI], non-fatal stroke [NFS], or CV-death) between 2022-2024 were identified from Hospital Episode Statistics (HES) and linked Office of National Statistics (ONS) mortality data. NFS and NMI events were identified by primary ICD-10 diagnosis codes with survival ≥30 days, while CV-death was defined as death with a CV-related primary cause in ONS data. Study endpoints - including baseline demographics, mortality, and CV-related attendances per person-years before (since 2015) and after (to end of 2024) first MACE / index - were compared between men and women based on person-stated gender in HES.
RESULTS: More men (405,959) than women (291,008) presented with MACE between 2022-24 (mean age of women / men at first MACE: 77 / 71 years; p<0.001). Yet, a higher proportion of women (37%, 108,499) than men (31%, 125,660) had CV-death as first MACE. NMI was more frequent in men (36% [146,998] vs.24% [70,501]), while NFS was more frequent in women (38% [112,008] vs.33% [133,306];overall p<0.001). More men had a history of revascularisation (8% [31,498] vs 3% [9,194;p<0.001] while more women had prior transient ischaemic attacks (3% [7,411] vs 2% [7693];p<0.001). Pre-MACE A&E attendances were 12% lower in men than women (IRR:0.88 [95%CI: 0.87,0.89]; p<0.001). Women had higher subsequent CV-related mortality (p<0.001) with a 3-year CV-related death rate (cumulative incidence) of 16% vs. 12% in men.
CONCLUSIONS: Gender differences exist in MACE incidence and outcomes: men have more events, yet women have higher mortality and prior emergency-care use, potentially suggesting suboptimal routes to CV care.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EPH266
Topic
Epidemiology & Public Health, Health Service Delivery & Process of Care, Real World Data & Information Systems
Disease
Cardiovascular Disorders (including MI, Stroke, Circulatory), No Additional Disease & Conditions/Specialized Treatment Areas