Table 1_Sex differences in hospital outcomes of medically-managed type B aortic dissection.docx

BackgroundMedical management is recommended for uncomplicated type B aortic dissection (TBAD). However, data focused on sex differences in outcomes in TBAD patients managed medically are limited.
MethodsHospitalizations of adults with TBAD were identified using the 2016–2019 Nationwide Readmissions Database. TBAD diagnosis was deduced by inclusion of thoracic or thoracoabdominal aorta dissection and exclusion of presumed type A aortic dissection. Hospitalizations associated with intervention were excluded. Multivariable logistic regression modeling was used to investigate the association of sex with in-hospital mortality. A Cox proportional hazards model was used to assess the association between sex and readmission rates.
ResultsThere were 52,269 TBAD hospitalizations (58% male). Compared to men, women were older (72 vs. 65 years), had higher in-hospital mortality (11.5% vs. 8.5%), shorter median length of stay (3.95 vs. 4.23 days), and lower rates of elective admissions (6.4% vs. 8.2%) (all p < 0.05). Despite similar rates of hypertension, lower rates of coronary artery disease and smoking, and decreased rates of hospital-related complications, women experienced increased adjusted in-hospital mortality (odds ratio: 1.16; 95% CI, 1.06–1.27). There were no sex differences in readmission risk at 30, 90, and 180 days.
ConclusionsWomen with TBAD managed medically experienced higher in-hospital mortality than men despite lower rates of atherosclerotic disease and risk factors. However, there were no sex differences in readmission risk at 30, 90, and 180 days. Prior research has demonstrated sex differences in presenting TBAD characteristics, including older age, varied signs/symptoms, and diagnostic delay in women. Data are needed to delineate additional causes of adverse acute outcomes in women managed medically, including condition- and medication-specific factors.

**背景**：对于非复杂性B型主动脉夹层（type B aortic dissection, TBAD），推荐采用内科保守治疗。然而，针对接受内科管理的TBAD患者预后的性别差异相关研究数据仍较为有限。

**方法**：本研究利用2016-2019年全国再入院数据库（Nationwide Readmissions Database）筛选成人TBAD患者的住院病例。TBAD的诊断通过纳入胸主动脉或胸腹主动脉夹层、排除疑似A型主动脉夹层来确定。与手术干预相关的住院病例被排除在外。本研究采用多变量logistic回归模型分析性别与住院死亡率的关联，并使用Cox比例风险模型评估性别与再入院率之间的关联。

**结果**：本研究共纳入52269例TBAD住院病例，其中男性占比58%。与男性患者相比，女性患者年龄更大（72岁 vs 65岁），住院死亡率更高（11.5% vs 8.5%），中位住院时长更短（3.95天 vs 4.23天），择期入院率更低（6.4% vs 8.2%），上述差异均具有统计学意义（所有p<0.05）。尽管女性患者的高血压患病率与男性相当，但冠状动脉疾病患病率、吸烟率更低，且医院相关并发症发生率也更低，但校正后的住院死亡率仍显著升高（优势比：1.16；95%置信区间：1.06~1.27）。在30天、90天及180天的再入院风险方面，未观察到性别差异。

**结论**：接受内科保守治疗的TBAD女性患者住院死亡率高于男性，尽管其动脉粥样硬化性疾病及相关危险因素的患病率更低。然而，在30天、90天及180天的再入院风险方面，未观察到性别差异。既往研究已证实TBAD患者的临床表现存在性别差异，包括女性患者年龄更大、症状表现多样以及诊断延迟。未来仍需更多研究来阐明接受内科治疗的女性患者出现不良急性结局的其他潜在原因，包括疾病特异性及药物特异性相关因素。