Sex differences in stroke case fatality: a meta-analysis

Zhou, Guoqing; Nie, Shengjie; Dai, Li-Jing; Wang, X.; Fan, Wenjie

doi:10.1111/ane.12091

Cited by 17 publications

(13 citation statements)

References 63 publications

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“…Nonetheless, uncertainty exists about how stroke affects the 2 sexes in terms of survival and severity. In some studies, the ability to survive was unrelated to sex, whereas in others, survival was either better or worse in women than in men . Similar uncertainty is seen in studies of stroke severity in men and women …”

Section: Introductionmentioning

confidence: 86%

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Sex Disparities in Stroke: Women Have More Severe Strokes but Better Survival Than Men

Dehlendorff

Andersen

Olsen

2015

JAHA

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BackgroundUncertainty remains about whether stroke affects men and women similarly. We studied differences between men and women with regard to stroke severity and survival.Methods and ResultsWe used the Danish Stroke Registry, with information on all hospital admissions for stroke in Denmark between 2003 and 2012 (N=79 617), and the Danish Register of Causes of Death. Information was available on age, sex, marital status, stroke severity, stroke subtype, socioeconomic status, and cardiovascular risk profile. We studied only deaths due to the index stroke, with the assumption that death reported on death certificates as due to stroke was related to the index stroke if death occurred within the first week or month after stroke. Multivariate Cox regression analysis and multiple imputation were applied. Stroke was the cause of death for 4373 and 5512 of the 79 617 patients within 1 week (5.5%) or 1 month (6.9%), respectively. After the age of 60 years, women had more severe strokes than men. Up to ages in the mid-60s, no difference in the risk of death from stroke was seen between the 2 sexes. For people aged >65 years, however, the risk gradually became greater in men than in women and significantly so (>15%) from the mid-70s (adjusted for age, marital status, stroke severity, stroke subtype, socioeconomic status, and cardiovascular risk factors). Results were essentially the same when analyzing deaths within 1 week, 1 month and ischemic and hemorrhagic stroke separately.ConclusionsStroke affects women and men differently. Elderly women were affected more severely than elderly men but were more likely to survive.

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Section: Introductionmentioning

confidence: 86%

“…In some studies, the ability to survive was unrelated to sex, whereas in others, survival was either better or worse in women than in men. [2][3][4] Similar uncertainty is seen in studies of stroke severity in men and women. 4,5 Knowledge about the severity of the stroke leading to death is a prerequisite for studies of survival after stroke.…”

mentioning

confidence: 94%

Sex Disparities in Stroke: Women Have More Severe Strokes but Better Survival Than Men

Dehlendorff

Andersen

Olsen

2015

JAHA

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“…[4][5][6][7][8][9][10] The direction of these differences is inconsistent. Women experiencing cardiac arrest were less likely to receive basic or advanced life support measures 4 ; women experiencing ST-elevation myocardial infarction were less likely to receive evidence-based medications and timely revascularization 6,11 ; and women with chronic liver disease were less likely to undergo transplantation 8 .…”

Section: Introductionmentioning

confidence: 99%

Differences in Terminal Hospitalization Care Between U.S. Men and Women

Just

Casarett

Asch

et al. 2016

Journal of Pain and Symptom Management

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“…In recent years, a growing interest in gender differences relating to stroke has been observed worldwide [3]. However, most studies on gender differences in stroke have focused on total or ischemic stroke [3–5], and few studies have separately explored gender differences in ICH, particularly concerning differences in functional outcomes [6–8].…”

Section: Introductionmentioning

confidence: 99%

“…However, most studies on gender differences in stroke have focused on total or ischemic stroke [3–5], and few studies have separately explored gender differences in ICH, particularly concerning differences in functional outcomes [6–8]. In addition, the results from these studies have been conflicting.…”

Section: Introductionmentioning

confidence: 99%

Sex differences in clinical characteristics and outcomes after intracerebral haemorrhage: results from a 12-month prospective stroke registry in Nanjing, China

et al. 2014

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BackgroundThere is uncertainty surrounding the differences in outcomes after intracerebral haemorrhage (ICH) between men and women. This study aimed to investigate the sex differences in clinical characteristics, severity and outcomes of Chinese ICH patients.MethodsThe Nanjing First Hospital stroke registry was a hospital-based registry of stroke patients with 1-year prospective follow-up. From 2004 to 2008, a total of 651 consecutively recruited patients with acute ICH were enrolled. Primary outcome was death or dependency defined as a modified Rankin Scale score of 3–6 at 12 months. Multivariable logistic regression analyses were performed to determine whether there were sex differences in clinical outcomes after ICH. Clinically important and biologically plausible risk factors of death or dependency were selected from available variables.ResultsA total of 615 ICH patients were enrolled. There was no significant difference in age (63.5 ± 14.0 vs. 62.7 ± 12.7, p = 0.500) between women and men. At baseline, men were more likely to be current smokers (46.1% vs. 3.6%, P < 0.001) or current drinkers (35.4% vs. 3.6%, P < 0.001), but women had higher admission National Institute of Health Stroke Scale (NIHSS) scores than men (10 vs. 8, P = 0.039). Women also had higher rates of death or dependency at 3, 6, and 12 months (61.2% vs. 46.8%, P = 0.001; 56.7% vs. 45.3%, P = 0.009; and 51.8% vs. 44.1%, P = 0.065; respectively). After adjustment for age, existing hypertension and diabetes, prior stroke, previous ischemic heart disease, previous atrial fibrillation, current smoking and alcohol consumption status, pre-stroke dependency, onset-to-door time, admission NIHSS score, admission systolic blood pressure and location of bleeding, the association between the female gender and death or dependency remained statistical significant at 3 months [odds ratio (OR): 1.76; 95% confidence interval (CI): 1.07-2.89], but did not reach statistical significance at 6 months (OR: 1.59; 95% CI: 0.99-2.54) and 12 months (OR: 1.22; 95% CI: 0.77-1.95).ConclusionsIn a Chinese population, women are more likely to be dead or dependent early after ICH than men. However, this gender difference gradually attenuates over the period of 12 months.

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Sex differences in stroke case fatality: a meta-analysis

Abstract: Due to the limited data about sex differences in stroke case fatality, the findings should be treated cautiously as preliminary. More large multicenter clinical trials should be performed to verify the reliability of the results.

Cited by 17 publications

References 63 publications

Sex Disparities in Stroke: Women Have More Severe Strokes but Better Survival Than Men

Sex Disparities in Stroke: Women Have More Severe Strokes but Better Survival Than Men

Differences in Terminal Hospitalization Care Between U.S. Men and Women

Sex differences in clinical characteristics and outcomes after intracerebral haemorrhage: results from a 12-month prospective stroke registry in Nanjing, China

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