Sex Disparities in Acute Myocardial Infarction Hospitalization, Mortality, and Coronary Angioplasty in the Brazilian Public Health System: A Nationwide Time-Series Study From 2008 to 2024

BackgroundWomen with acute myocardial infarction are treated less invasively than men and die in hospital more often.Whether expanding acute coronary care narrows these differences is unknown. MethodsWe conducted a nationwide time-series study of the Brazilian public health system from 2008 through 2024.Outcomes were hospitalization with acute myocardial infarction (ICD-10 I21-I23) as the principal diagnosis, death with infarction as the underlying cause, and admission for infarction with coronary angioplasty.Rates were standardized by age and sex to the 2022 Census.Trends were estimated by Prais-Winsten regression, and change in the sex disparity was tested as a sex-by-year interaction. ResultsWe analyzed 1,927,152 admissions, 1,513,299 deaths, and 543,290 angioplasty admissions.From 2008 to 2024 the age-standardized hospitalization rate rose from 59.8 to 111.7 per 100,000 in men and from 33.8 to 60.0 per 100,000 in women (annual percent change, +3.69% and +3.34%); mortality fell from 69.0 to 54.4 per 100,000 in men and from 46.8 to 34.1 per 100,000 in women (-1.44% and -1.92%, respectively); and angioplasty rose from 11.1 to 41.8 per 100,000 in men and from 5.0 to 20.1 per 100,000 in women (+8.22% and +8.17%, respectively).The men-to-women rate ratio stayed within narrow bands (hospitalization, 1.76 to 1.87; mortality, 1.47 to 1.60; angioplasty, 2.08 to 2.22), and no sex-by-year interaction was significant (p=0.20,p=0.10 and p=0.24).Among admitted patients, standardized in-hospital case fatality fell from 12.9% to 7.0% in men and from 16.1% to 8.3% in women.Women had higher case fatality in every year and every age group from 40 years onward; the adjusted relative risk of in-hospital death for men as compared with women was 0.84 (95% CI, 0.83 to 0.85) and did not change over time (p=0.89). ConclusionsBrazil's public system expanded admission and angioplasty for myocardial infarction; outcomes improved in both sexes, but the gap between them did not close.