1 Menzies Institute for Medical Research Tasmania University of Tasmania Hobart Australia.
2 Department of Health Management and Health Economics Pham Ngoc Thach University of Medicine Ho Chi Minh City Vietnam.
J Am Heart Assoc. 2019 Jan 8;8(1):e010235. doi: 10.1161/JAHA.118.010235.
Background Women have worse outcomes after stroke than men, and this may be partly explained by stroke severity. We examined factors contributing to sex differences in severity of acute stroke assessed by the National Institutes of Health Stroke Scale. Methods and Results We pooled individual participant data with National Institutes of Health Stroke Scale assessment (N=6343) from 8 population-based stroke incidence studies (1996-2014), forming part of INSTRUCT (International Stroke Outcomes Study). Information on sociodemographics, stroke-related clinical factors, comorbidities, and pre-stroke function were obtained. Within each study, relative risk regression using log-binominal modeling was used to estimate the female:male relative risk ( RR ) of more severe stroke (National Institutes of Health Stroke Scale>7) stratified by stroke type (ischemic stroke and intracerebral hemorrhage). Study-specific unadjusted and adjusted RR s, controlling for confounding variables, were pooled using random-effects meta-analysis. National Institutes of Health Stroke Scale data were recorded in 5326 (96%) of 5570 cases with ischemic stroke and 773 (90%) of 855 participants with intracerebral hemorrhage. The pooled unadjusted female:male RR for severe ischemic stroke was 1.35 (95% CI 1.24-1.46). The sex difference in severity was attenuated after adjustment for age, pre-stroke dependency, and atrial fibrillation but remained statistically significant (pooled RR 1.20, 95% CI 1.10-1.30). There was no sex difference in severity for intracerebral hemorrhage ( RR 1.08, 95% CI 0.97-1.21; RR 1.08, 95% CI 0.96-1.20). Conclusions Although women presented with more severe ischemic stroke than men, much although not all of the difference was explained by pre-stroke factors. Sex differences could potentially be ameliorated by strategies to improve pre-stroke health in the elderly, the majority of whom are women. Further research on the potential biological origin of sex differences in stroke severity may also be warranted.
背景 女性在中风后预后比男性差，这可能部分归因于中风的严重程度。我们研究了影响美国国立卫生研究院中风量表评估的急性中风严重程度的性别差异的因素。
方法和结果 我们从 8 项基于人群的中风发病率研究（1996-2014 年）中汇集了具有美国国立卫生研究院中风量表评估的个体参与者数据（N=6343），这些研究构成了 INSTRUCT（国际中风结局研究）的一部分。收集了社会人口统计学、与中风相关的临床因素、合并症和中风前功能的信息。在每个研究中，使用对数二项式模型的相对风险回归估计了按中风类型（缺血性中风和脑内出血）分层的更严重中风（美国国立卫生研究院中风量表>7）的女性与男性的相对风险（RR）。使用随机效应荟萃分析汇总了研究特定的未调整和调整后的 RR，控制了混杂变量。5326 例（96%）缺血性中风病例和 773 例（90%）脑内出血患者记录了美国国立卫生研究院中风量表数据。未调整的女性与男性严重缺血性中风的 RR 为 1.35（95%CI 1.24-1.46）。调整年龄、中风前依赖和房颤后，严重程度的性别差异减弱，但仍具有统计学意义（汇总 RR 1.20，95%CI 1.10-1.30）。脑内出血严重程度无性别差异（RR 1.08，95%CI 0.97-1.21；RR 1.08，95%CI 0.96-1.20）。
结论 尽管女性的缺血性中风比男性更严重，但中风前因素解释了这种差异的大部分（尽管不是全部）。通过改善老年人的中风前健康状况（其中大多数是女性），可能会减轻性别差异。进一步研究中风严重程度的性别差异的潜在生物学原因可能也是必要的。
