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We then sequentially added age and the interaction of sex by age to determine the extent to which age modified the estimated HR for sex.With respect to cardiovascular mortality, we further used a series of Fine and Gray regression models to assess the potential effect modifications by groups of variables on the associations of sex and risk of death with age.The potential effect modifications were assessed with 3 groups of covariates: (1) age; (2) age, reperfusion therapy, and medical therapy; and (3) age, diabetes mellitus, hypertension, renal failure, AMI category, and Killip class.Age was modeled as a categorical variable (22–49, 50–59, 60–69, 70–79, and 80–101 years) because a significant departure from linear trend was found.
For cardiovascular and noncardiovascular deaths, the first model within each ethnic group included sex as an explanatory variable.The study was conducted according to the Declaration of Helsinki, and the National Healthcare Group Domain Specific Review Board approved the data analysis and collection in all 6 publicly funded hospitals in Singapore.The requirement for written informed consent was waived.The ICD‐9 and ICD‐10 were used to code and classify mortality data from death certificates. Any disagreement in classification was resolved by consensus. Survival time was calculated from the index hospital admission for AMI to the date of the specific cause of death or date of censor.
It is a statutory requirement that deaths be registered within 24 hours of occurrence. To study the extent to which the risk of noncardiovascular death competed with the risk of cardiovascular death, these 2 broad categories were compared within each sex–ethnicity group.
The cardiovascular causes were subclassified as coronary heart disease, stroke, diabetes mellitus complications, heart failure or cardiomyopathy, and other cardiovascular. The cumulative incident death rates in the presence of competing events were estimated using the delta method.17 To assess the effects of sex and ethnicity, we used the Fine and Gray18 regression model, which is a modification of the Cox model and permits analysis of a particular cause of death to suitably account for the remaining and thus competing causes.