Sex and Race Differences in the Association of Incident Ischemic Stroke With Risk Factors

Howard, Virginia J.; Madsen, Tracy E.; Kleindorfer, Dawn; Judd, Suzanne E.; Rhodes, J.; Soliman, Elsayed Z.; Kissela, Brett M; Safford, Monika M.; Moy, Claudia S.; McClure, Leslie A.; Howard, George; Cushman, Mary

doi:10.1001/jamaneurol.2018.3862

Cited by 111 publications

(75 citation statements)

References 44 publications

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“…Racial disparities are well documented in all aspects of stroke as it relates to differences in stroke risk factors, incidence, prevalence, and symptom recognition in comparison to the White population [11]. While disparity in stroke may partially be explained by geography [13], neighborhood socioeconomic status [14], or age [15], there is substantial evidence emphasizing racial predisposition to stroke. The first-stroke risk at age 45 is 2.7 times higher in Black individuals compared to White individuals, with Black patients having higher rates of ischemic and hemorrhagic stroke [16].…”

Section: Discussionmentioning

confidence: 99%

Racial Disparity Amongst Stroke Patients During the Coronavirus Disease 2019 Pandemic

Ghanchi¹,

Patchana²,

Wiginton³

et al. 2020

Cureus

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The global coronavirus disease 2019 (COVID-19) pandemic has had deleterious effects on our healthcare system. Lockdown measures have decreased the number of patients presenting to the hospital for non-respiratory illnesses, such as strokes. Moreover, there appears to be a racial disparity among those afflicted with the virus. We sought to assess whether this disparity also existed for patients presenting with strokes. Methods The Get with the Guidelines National Stroke Database was reviewed to assess patients presenting with a final diagnosis of ischemic stroke, transient ischemic attack (TIA), subarachnoid hemorrhage (SAH), or spontaneous/nontraumatic intraparenchymal hemorrhage (IPH). The period of February-May 2020 was chosen given the surge of patients affected with the virus and national shutdowns. Data from this same time during 2019 was used as the control population. Our hospital numbers and four additional regions were assessed (California hospitals, Pacific State hospitals, Western Region hospitals, and all hospitals in the United States). Patients were categorized by race (White, Black/African American, Asian, Native American, Hispanic) in each cohort. The primary endpoint of this study is to compare whether there was a significant difference in the proportion of patients in each reported racial category presenting with stroke during the COVID-19 pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Results A downward trend in total number of patients was noted in all five regional cohorts assessed. A statistically significant increase in the number of Black and Hispanic patients presenting with strokes was noted in California, Pacific hospitals, Western hospitals, and all hospitals in the United States during various months studied comparing 2020 to 2019. A statistically significant increase in the Hispanic population was noted in February and March in all California hospitals (p=0.005 and 0.02, respectively) and Pacific Coast hospitals (p=0.005 and 0.039, respectively). The Western region and all national hospitals noted a significant increase in strokes in the Hispanic population in April (p=0.039 and 0.023, respectively). A statistically significant increase of strokes in the Black population was noted in April in Pacific hospitals,

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Section: Discussionmentioning

confidence: 99%

Racial Disparity Amongst Stroke Patients During the Coronavirus Disease 2019 Pandemic

Ghanchi¹,

Patchana²,

Wiginton³

et al. 2020

Cureus

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“…Therefore, differences in treatment and management may explain a large component of the excess risk associated with diabetes in women. In addition, women have less stroke risk factors compared with men (86), so the effect of adding one risk factor (such as diabetes) on women may be more serious.…”

Section: Discussionmentioning

confidence: 99%

Risk of all-cause and CHD mortality in women versus men with type 2 diabetes: a systematic review and meta-analysis

You

Wong

et al. 2019

European Journal of Endocrinology

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Objective Previous studies have shown sex-specific differences in all-cause and CHD mortality in type 2 diabetes. We performed a systematic review and meta-analysis to provide a global picture of the estimated influence of type 2 diabetes on the risk of all-cause and CHD mortality in women vs men. Methods We systematically searched PubMed, EMBASE and Web of Science for studies published from their starting dates to Aug 7, 2018. The sex-specific hazard ratios (HRs) and their pooled ratio (women vs men) of all-cause and CHD mortality associated with type 2 diabetes were obtained through an inverse variance-weighted random-effects meta-analysis. Subgroup analyses were used to explore the potential sources of heterogeneity. Results The 35 analyzed prospective cohort studies included 2 314 292 individuals, among whom 254 038 all-cause deaths occurred. The pooled women vs men ratio of the HRs for all-cause and CHD mortality were 1.17 (95% CI: 1.12–1.23, I2 = 81.6%) and 1.97 (95% CI: 1.49–2.61, I2 = 86.4%), respectively. The pooled estimate of the HR for all-cause mortality was approximately 1.30 in articles in which the duration of follow-up was longer than 10 years and 1.10 in articles in which the duration of follow-up was less than 10 years. The pooled HRs for all-cause mortality in patients with type 2 diabetes was 2.33 (95% CI: 2.02–2.69) in women and 1.91 (95% CI: 1.72–2.12) in men, compared with their healthy counterparts. Conclusions The effect of diabetes on all-cause and CHD mortality is approximately 17 and 97% greater, respectively, for women than for men.

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“…Men have a higher incidence of stroke than women at younger ages, with the incidence reversed by the age of 75 years, although recent data suggests this may not be the case for black people as the stroke risk for black women aged 65 to 74 years was similar when compared with black men. [4,8] The finding could be driven by race and sex group differences for stroke risk factors, mainly hypertension. [8]…”

mentioning

confidence: 99%

“…[4,8] The finding could be driven by race and sex group differences for stroke risk factors, mainly hypertension. [8]…”

mentioning

confidence: 99%

Hypertension and Stroke: Update on Treatment

Wajngarten¹,

2019

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Stroke is the second most common cause of mortality worldwide and the third most common cause of disability. Hypertension is the most prevalent risk factor for stroke. Stroke causes and haemodynamic consequences are heterogeneous which makes the management of blood pressure in stroke patients complex requiring an accurate diagnosis and precise definition of therapeutic goals. In this article, the authors provide an updated review on the management of arterial hypertension to prevent the first episode and the recurrence. They also present a discussion on blood pressure management in hypertensive urgencies and emergencies, especially in the acute phase of hypertensive encephalopathy, ischaemic stroke and haemorrhagic stroke.

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Sex and Race Differences in the Association of Incident Ischemic Stroke With Risk Factors

Cited by 111 publications

References 44 publications

Racial Disparity Amongst Stroke Patients During the Coronavirus Disease 2019 Pandemic

Racial Disparity Amongst Stroke Patients During the Coronavirus Disease 2019 Pandemic

Risk of all-cause and CHD mortality in women versus men with type 2 diabetes: a systematic review and meta-analysis

Hypertension and Stroke: Update on Treatment

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