Back to Annual Meeting Page		American Public Health Association 133rd Annual Meeting & Exposition December 10-14, 2005 Philadelphia, PA

Abstract #119112

Mary A.M. Rogers, PhD¹, Kenneth M. Langa, MD, PhD¹, Catherine Kim, MD, MPH¹, Brahmajee K. Nallamothu, MD, MPH¹, Preeti N. Malani, MD², Laurence F. McMahon, MD, MPH¹, Brant E. Fries, PhD³, Samuel R. Kaufman, MA⁴, and Sanjay Saint, MD, MPH⁴. (1) Department of Internal Medicine, University of Michigan, Division of General Medicine, 300 N. Ingalls, Suite NI7E07, Ann Arbor, MI 48109-0429, 734-647-8851, maryroge@umich.edu, (2) Department of Infectious Diseases, University of Michigan, 3116 TC, Ann Arbor, MI 48109, (3) Institute of Gerontology, University of Michigan, 300 N. Ingalls Room 935, Ann Arbor, MI 48109, (4) Department of Internal Medicine, The University of Michigan, 300 N. Ingalls, Ann Arbor, MI 48109-0429

Women have elevated short-term mortality after coronary artery bypass graft (CABG) surgery when compared with men. Explanations for this gender difference have been controversial. Our objective was to assess whether the increased risk of mortality after CABG surgery in women is related to gender differences in the prevalence of infection. A cohort study was conducted with 9218 Michigan Medicare beneficiaries hospitalized for CABG surgery. Information regarding the prevalence of infection at any site during the hospital stay was collected. The primary outcome was mortality within the 100-day period after CABG surgery. Women hospitalized for CABG surgery were more likely to have an infection than men (16.1% vs. 9.8%, p<0.001), regardless of age, race, type of admission, hospital volume, or presence of various co-morbidities. Infections of the urinary tract, digestive tract, respiratory tract, and skin and subcutaneous tissue were more common in women than men. Once infected, however, men were more likely to die than women (p=0.008). The percentage of deaths attributable to female gender was 13.9%, which decreased to 0.3% when adjusted for the prevalence of infection. Of the excess deaths in women after CABG surgery, 96% could be accounted for by the differential distribution of infection across gender; neither hospital length of stay nor the prevalence of various co-morbidities appreciably changed this effect. Our results suggest that the increased risk of mortality after CABG surgery in women may be explained by underlying differences in the prevalence of infection between men and women.

Learning Objectives:

• Describe the gender effect on mortality after CABG surgery.
• Discuss the reasons for this gender effect in hospitalized patients.
• Identify the interaction between infection and mortality in women and men.
• Recognize how risk attributable to female gender changes with adjustment for infection.
• Articulate how two competing forces may influence an overall effect.
• Discuss implications of this relation between infection and mortality in women and men.

Keywords: Gender, Infectious Diseases

Presenting author's disclosure statement:

I wish to disclose that I have NO financial interests or other relationship with the manufactures of commercial products, suppliers of commercial services or commercial supporters.