Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia.
Department of Public Health Management, Pham Ngoc Thach University of Medicine, Hồ Chí Minh, Vietnam.
J Womens Health (Larchmt). 2021 Mar;30(3):314-323. doi: 10.1089/jwh.2020.8391. Epub 2020 Nov 23.
We examined sex differences in cause of death and cause-specific excess mortality after stroke. First-ever strokes (2010-2013; 35 hospitals) participating in the Australian Stroke Clinical Registry were linked to national death registrations and other administrative datasets. One-year cause-specific mortality was categorized as stroke, ischemic heart disease, other cardiovascular disease (CVD; , hypertension), cancer, and other. Specific hazard ratios (sHRs) of death for women compared to men were estimated using competing risk models, with adjustment for factors differing by sex (, age and stroke severity). Age- and sex-specific mortality rates expected in the general population were derived from national data. Standardized mortality ratios (SMRs; observed/expected deaths) were estimated for cause-specific mortality by sex after age standardization. Among 9,441 cases (46% women), women were 7 years older than men, had more severe strokes, and received similar patterns of suboptimal secondary prevention medications at discharge. Women had greater mortality associated with stroke (sHR 1.65) and other CVD (sHR 1.65), which was related to age and stroke severity rather than other factors. Compared to population norms, those surviving to 30 days had eight-fold increased mortality from stroke (primary/recurrent) events irrespective of sex (SMR women 8.8; men 8.3). Excess mortality from other CVD was greater in women (SMR 3.6 vs. men 2.8; = 0.026). Cause-specific mortality after first-ever stroke differs by sex. The greater death rate attributed to stroke/other CVD in women was mostly explained by age and stroke severity. Greater implementation of secondary stroke prevention is relevant to both sexes.
我们研究了卒中后死亡原因和特定原因超额死亡率的性别差异。参与澳大利亚卒中临床登记处的首次卒中（2010-2013 年；35 家医院）与国家死亡登记处和其他行政数据集相关联。将 1 年特定原因死亡率分为卒中、缺血性心脏病、其他心血管疾病（CVD；高血压）、癌症和其他原因。使用竞争风险模型估计女性与男性相比的死亡特定危险比（sHR），并根据性别差异的因素进行调整（年龄和卒中严重程度）。从国家数据中得出了一般人群中预期的年龄和性别特异性死亡率。通过性别对特定原因死亡率进行标准化死亡率比（SMR；观察到的/预期死亡）估计，在年龄标准化后。在 9441 例病例中（46%为女性），女性比男性年长 7 岁，卒中更严重，出院时接受的次优二级预防药物模式相似。女性的卒中相关死亡率更高（sHR 1.65）和其他 CVD（sHR 1.65），这与年龄和卒中严重程度有关，而与其他因素无关。与人群标准相比，无论性别如何，那些存活至 30 天的患者卒中（原发性/复发性）事件的死亡率增加了 8 倍（女性 SMR 8.8；男性 SMR 8.3）。其他 CVD 的超额死亡率女性更高（SMR 3.6 比男性 2.8； = 0.026）。首次卒中后的特定原因死亡率存在性别差异。女性归因于卒中/其他 CVD 的死亡率更高，主要原因是年龄和卒中严重程度。更广泛地实施二级卒中预防对两性都相关。
