Supplementary Material for: Difference in long-term mortality after Takotsubo Syndrome. The role of gender, disease burden, socioeconomic profile, and psychological distress.

Introduction While Takotsubo Syndrome (TTS) is less common in men, their mortality rates surpass those of women. The influence of socioeconomic factors and psychological distress remains unexplored. This study aimed to investigate gender differences in socioeconomic profiles and psychological distress among patients with incident TTS, and to examine gender differences in survival after discharge, accounting for socioeconomic and psychological factors. Methods A nationwide cohort study using national registers included all patients discharged from Danish hospitals with an incident TTS diagnosis were eligible. Socioeconomic factors, including marital status, cohabitation status, labor market attachment, highest formal education, family income, and psychological distress, were assessed and compared. Cox regression models were applied to analyze the data. Results Of 662 patients with Takotsubo Syndrome discharged alive 79 (11.9%) were men with a median age of 67 years (IQR 62–77). Men with TTS were socioeconomically disadvantaged compared to women. Unadjusted analyses indicated that male gender was associated with increased mortality (HR 2.61, 95% CI 1.18–3.25, P=0.009). Low income, living alone, being widowed, and receiving a retirement pension were all significantly associated with three-year mortality risk. However, in the main adjusted model, aside from the gender difference, only the Charlson Comorbidity Index was significantly associated with a higher mortality risk (HR 1.26, 95% CI 1.15–1.39, P<0.001). No significant interactions between gender and socioeconomic variables were observed. Conclusion Men with TTS experienced greater socioeconomic disadvantages and higher three-year mortality than women, with comorbidity scores significantly influencing outcomes in both genders.