Lambert Clare, Chaudhary Durgesh, Olulana Oluwaseyi, Shahjouei Shima, Avula Venkatesh, Li Jiang, Abedi Vida, Zand Ramin
Geisinger NeuroScience Institute, Geisinger Health System, Danville, PA, USA.
Department of Molecular and Functional Genomics, Weis Center for Research, Geisinger Health System, Danville, PA, USA.
Ther Adv Neurol Disord. 2020 Dec 18;13:1756286420971895. doi: 10.1177/1756286420971895. eCollection 2020.
Several studies suggest women may be disproportionately affected by poorer stroke outcomes than men. This study aims to investigate whether women have a higher risk of all-cause mortality and recurrence after an ischemic stroke than men in a rural population in central Pennsylvania, United States.
We analyzed consecutive ischemic stroke patients captured in the Geisinger NeuroScience Ischemic Stroke research database from 2004 to 2019. Kaplan-Meier (KM) estimator curves stratified by gender and age were used to plot survival probabilities and Cox Proportional Hazards Ratios were used to analyze outcomes of all-cause mortality and the composite outcome of ischemic stroke recurrence or death. Fine-Gray Competing Risk models were used for the outcome of recurrent ischemic stroke, with death as the competing risk. Two models were generated; Model 1 was adjusted by data-driven associated health factors, and Model 2 was adjusted by traditional vascular risk factors.
Among 8900 adult ischemic stroke patients [median age of 71.6 (interquartile range: 61.1-81.2) years and 48% women], women had a higher crude all-cause mortality. The KM curves demonstrated a 63.3% survival in women compared with a 65.7% survival in men ( = 0.003) at 5 years; however, the survival difference was not present after controlling for covariates, including age, atrial fibrillation or flutter, myocardial infarction, diabetes mellitus, dyslipidemia, heart failure, chronic lung diseases, rheumatic disease, chronic kidney disease, neoplasm, peripheral vascular disease, past ischemic stroke, past hemorrhagic stroke, and depression. There was no adjusted or unadjusted sex difference in terms of recurrent ischemic stroke or composite outcome.
Sex was not an independent risk factor for all-cause mortality and ischemic stroke recurrence in the rural population in central Pennsylvania.
多项研究表明，与男性相比，女性可能在中风后出现较差预后的情况更为严重。本研究旨在调查在美国宾夕法尼亚州中部农村地区，缺血性中风后女性的全因死亡率和复发风险是否高于男性。
我们分析了2004年至2019年在盖辛格神经科学缺血性中风研究数据库中连续纳入的缺血性中风患者。采用按性别和年龄分层的Kaplan-Meier（KM）估计曲线绘制生存概率，并使用Cox比例风险比分析全因死亡率以及缺血性中风复发或死亡的复合结局。对于复发性缺血性中风的结局，采用Fine-Gray竞争风险模型，将死亡作为竞争风险。生成了两个模型；模型1通过数据驱动的相关健康因素进行调整，模型2通过传统血管危险因素进行调整。
在8900例成年缺血性中风患者中[中位年龄为71.6岁（四分位间距：61.1 - 81.2岁），女性占48%]，女性的粗全因死亡率更高。KM曲线显示，5年后女性的生存率为63.3%，男性为65.7%（P = 0.003）；然而，在控制了包括年龄、心房颤动或扑动、心肌梗死、糖尿病、血脂异常、心力衰竭、慢性肺部疾病、风湿性疾病、慢性肾脏疾病、肿瘤、外周血管疾病、既往缺血性中风、既往出血性中风和抑郁症等协变量后，生存差异不再存在。在复发性缺血性中风或复合结局方面，未发现经调整或未经调整的性别差异。
在宾夕法尼亚州中部农村人口中，性别不是全因死亡率和缺血性中风复发的独立危险因素。
