Patients Hospitalized for Ischemic Stroke and Intracerebral Hemorrhage in France: Time Trends (2008–2019), In-Hospital Outcomes, Age and Sex Differences

Abstract

Background: Rates of patients hospitalized for stroke increased among people aged under 65 years in France, as has been found in other countries. Methods: To analyze time trends in the rates of patients hospitalized for ischemic stroke (IS) and intracerebral hemorrhage (ICH) in France between 2008 and 2019 and determine related short-term outcomes mainly, we selected all patients hospitalized for stroke using the French national hospital database. Results: The average annual percentage change in the rates of patients hospitalized for IS increased significantly in men and women aged 50–64 years (+2.0%) and in men aged 18–34 years (+1.5%) and 35–44 years (+2.2%). A decrease in the average annual percentage change was observed for IS among people aged over 75 years and among those over 50 years for ICH. After adjustment on confounding factors, women were less likely to die in hospital. Case fatality rates decreased overtime in all age groups for both sexes, with a more pronounced decrease for IS than ICH. Conclusions: The increasing trend of IS among adults under 65 years is ongoing, highlighting the urgent need for stroke prevention programs in that age. For the first time, we recorded a decrease in the rates of patients hospitalized for ICH among the population over 50 years.

Association of sex and age with in‐hospital mortality and complications of patients with intracerebral hemorrhage: A study from the Chinese Stroke Center Alliance

“…In terms of sex, some studies did not identify sex differences (Carcel et al., 2019 ) or age‐sex interaction effects (James et al., 2017 ) on mortality after ICH, while others found a higher mortality rate in females (Ganti et al., 2013 ; Nilsson et al., 2002 ; Purroy et al., 2019 ). In contrast, some studies have observed a lower mortality rate in females, especially in young and middle‐aged females after cross‐age grouping (Ayala et al., 2002 ; Bushnell et al., 2014 ; Olie et al., 2022 ; Sheikh & Bullock, 2007 ; Shigematsu et al., 2015 ; Umeano et al., 2013 ; Zia et al., 2009 ), which is similar to our findings. The reasons for these differences may be related to the different study types (retrospective vs. prospective), study populations (geographical vs. ethnic), inclusion criteria, analysis methods, and follow‐up evaluation methods.…”

“…Management of ICH needs to be based on sex differences to avoid misunderstandings and bias (The Lancet Network, 2019 ). There are previous contradictions regarding sex differences and mortality after ICH (Ayala et al., 2002 ; Bushnell et al., 2014 ; Carcel et al., 2019 ; Ganti et al., 2013 ; Nilsson et al., 2002 ; Purroy et al., 2019 ; Shigematsu et al., 2015 ; Sheikh & Bullock et al., 2007 ; Umeano et al., 2013 ; Zia et al., 2009 ). This may be due to the fact that aging affects the release of systemic substances in people of the same sex, affecting clinical recovery after ICH (Engman et al., 2012 ; Guevara et al., 2011 ; Hsieh et al., 2016 ; Lei et al., 2016 ).…”

Service delivery in acute ischemic stroke patients: Does sex matter?

“…A pooled analysis of five randomized controlled trials found that women were more likely to be admitted to an acute stroke unit [13], whereas other studies TA B L E 1 Overall and sex-specific unadjusted baseline characteristics of the population. from France and Canada did not confirm significant sex disparities in rates of stroke unit admission [14] or showed the contrary [15].…”

“…Reassuringly, such differences seem to decrease toward more sex equity over time; a recent nationwide analysis in the United States showed that in the past decade, utilization of rt‐PA increased at a faster pace in women compared to men [34]. This trend was confirmed by epidemiological data from France [15] and by the aforementioned meta‐analysis by Strong and coworkers [33]. Recent data from Catalonia for the period from 2016 to 2019 showed even a higher proportion of acute reperfusion therapies in women [24].…”

“…An older analysis from the GWTG Stroke program [12] showed that women received poorer quality of acute stroke care than men, whereas a recent large retrospective study in China [1] did not show significant sex differences in acute management and intrahospital and discharge performance measures. A pooled analysis of five randomized controlled trials found that women were more likely to be admitted to an acute stroke unit [13], whereas other studies from France and Canada did not confirm significant sex disparities in rates of stroke unit admission [14] or showed the contrary [15]. This same adjusted pooled analysis did not demonstrate that women were less likely to benefit from intensive care treatment and acute interventions such as intubation [13], nasogastric feeding [13], and treatment for fever [13].…”