Coronary heart disease (CHD) was the number one cause of death in the United States. The main CHD symptom was a heart attack. The most common form of a heart attack was chest pain and shortness of breath, which occurred in men. However, women did not usually have chest pain, but other symptoms such as abdominal pain or indigestion. This could lead women to perceive or believe that they would not have heart disease or heart attacks. This thought could lead women to not obtaining health care, such as surgical procedures, for CHD.

Health professionals knew the signs and symptoms of CHD in men, but they may be uncertain in their diagnosis in women. This could lead to women not asking their health care professional about heart attacks or other symptoms. The purpose of this dissertation analyzed CHD in two areas in all women 18 years and older. These two areas were: (a) comparing hospital length of stay between men and women who had either coronary artery bypass grafting (CABG) or percutaneous transluminal coronary angioplasty (PTCA); and (b) women’s perceptions about CHD.

Data for the surgical procedures study came from the 2006 National Hospital Discharge Survey (NHDS) and for the perception study came from the 2007 Behavioral Risk Factor Surveillance System (BRFSS). The results showed for the surgical procedures men and women had increased hospital days of care (DOC) for all surgical procedures. The results for the perception study showed women varied by age, race-ethnicity, education, income, and other factors in heart attack symptom knowledge.

These two studies had the following conclusions. The results for increased hospital DOC had implications, such as increased health utilization, for present and future hospitalizations. The results for heart attack symptom knowledge showed a need for more awareness and communication of heart attack symptoms among all women across the United States.

The incidence of hematologic malignancies following external beam radiation therapy (EBRT) among prostate cancer patients has received limited attention despite evidence that radiation has a role in leukemogenesis and myelomagenesis. Therefore, we investigated the effect of external beam radiation therapy on acute myeloid leukemia and myeloma incidence among prostate cancer patients. We utilized the Surveillance, Epidemiology, and End Results database to identify a cohort of men (n=168,612) with newly diagnosed prostate adenocarcinoma between January 1988 and December 2003. Cox proportional hazard regression was used to estimate the hazard ratios (HRs) and corresponding 95% confidence intervals (CIs) of acute myeloid leukemia and myeloma incidence following definitive therapy with EBRT alone, brachytherapy alone, or surgery alone compared to no definitive therapy. The cohort yielded 184 incident acute myeloid leukemia cases and 344 incident myeloma cases during 1,064,820 person-years of follow-up after prostate adenocarcinoma diagnosis. Patients treated with EBRT had a higher adjusted relative hazard of developing acute myeloid leukemia than patients treated with brachytherapy or surgery when each therapy group was compared to patients who were not

treated with definitive therapy (EBRT: HR=2.05, 95% CI 1.29, 3.26; brachytherapy: HR=1.22, 95% CI 0.46, 3.22; surgery: HR=1.24, 95% CI 0.77, 1.98). Patients treated with EBRT, brachytherapy, or surgery did not have increased adjusted relative hazards of developing myeloma when each therapy group was compared to patients who were not treated with definitive therapy (EBRT: HR=0.97, 95% CI: 0.70, 1.35; brachytherapy: HR=0.60, 95% CI: 0.28, 1.33; surgery: HR=1.02, 95% CI: 0.75, 1.39). Our findings suggest that acute myeloid leukemia incidence is a greater concern for patients treated with EBRT than brachytherapy for localized or locally advanced prostate adenocarcinoma. However, our results indicate that neither EBRT nor brachytherapy increases the relative hazard of myeloma incidence among patients with localized or locally advanced prostate adenocarcinoma. Ultimately, our findings may contribute to the collective evidence regarding the risks and benefits of external beam radiation therapy.