2016-18 年期间利用西班牙国家住院患者数据库进行的倾向性评分匹配分析：2 型糖尿病患者出血性卒中发生率和结局的性别差异。
Sex-related disparities in the incidence and outcomes of hemorrhagic stroke among type 2 diabetes patients: a propensity score matching analysis using the Spanish National Hospital Discharge Database for the period 2016-18.
机构信息
Department of Public Health & Maternal and Child Health, Faculty of Medicine, Universidad Complutense de Madrid, 28040, Madrid, Spain.
Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Alcorcón, Madrid, Spain.
出版信息
Cardiovasc Diabetol. 2021 Jul 9;20(1):138. doi: 10.1186/s12933-021-01334-2.
BACKGROUND
To analyze incidence, use of therapeutic procedures, use of oral anticoagulants (OACs) and antiplatelet agents prior to hospitalization, and in-hospital outcomes among patients who were hospitalized with hemorrhagic stroke (HS) according to the presence of type 2 diabetes mellitus (T2DM) in Spain (2016-2018) and to assess the role of sex differences among those with T2DM.
METHODS
Using the Spanish National Hospital Discharge Database we estimated the incidence of HS hospitalizations in men and women aged ≥ 35 years with and without T2DM. Propensity score matching (PSM) was used to compare population subgroups according to sex and the presence of T2DM.
RESULTS
HS was coded in 31,425 men and 24,975 women, of whom 11,915 (21.12%) had T2DM. The adjusted incidence of HS was significantly higher in patients with T2DM (both sexes) than in non-T2DM individuals (IRR 1.15; 95% CI 1.12-1.17). The incidence of HS was higher in men with T2DM than in T2DM women (adjusted IRR 1.60; 95% CI 1.57-1.63). After PSM, men and women with T2DM have significantly less frequently received decompressive craniectomy than those without T2DM. In-hospital mortality (IHM) was higher among T2DM women than matched non-T2DM women (32.89% vs 30.83%; p = 0.037), with no differences among men. Decompressive craniectomy was significantly more common in men than in matched women with T2DM (5.81% vs. 3.33%; p < 0.001). IHM was higher among T2DM women than T2DM men (32.89% vs. 28.28%; p < 0.001). After adjusting for confounders with multivariable logistic regression, women with T2DM had a 18% higher mortality risk than T2DM men (OR 1.18; 95% CI 1.07-1.29). Use of OACs and antiplatelet agents prior to hospitalization were associated to higher IHM in men and women with and without T2DM.
CONCLUSIONS
T2DM is associated with a higher incidence of HS and with less frequent use of decompressive craniectomy in both sexes, but with higher IHM only among women. Sex differences were detected in T2DM patients who had experienced HS, with higher incidence rates, more frequent decompressive craniectomy, and lower IHM in men than in women.
背景
分析 2016-2018 年在西班牙因出血性脑卒中（HS）住院的患者中，根据是否患有 2 型糖尿病（T2DM），分析发病率、治疗方法的使用、住院前使用口服抗凝剂（OAC）和抗血小板药物的情况，以及住院期间的结局，并评估 T2DM 患者中性别差异的作用。
方法
使用西班牙国家住院数据库，我们估计了≥35 岁的男性和女性中伴有和不伴有 T2DM 的 HS 住院率。采用倾向评分匹配（PSM）比较了根据性别和 T2DM 存在情况的人群亚组。
结果
31425 名男性和 24975 名女性被编码为 HS，其中 11915 名（21.12%）患有 T2DM。与非 T2DM 个体相比，T2DM 患者（无论性别）的 HS 发病率显著更高（调整发病率比[IRR]1.15；95%置信区间[CI]1.12-1.17）。与 T2DM 女性相比，患有 T2DM 的男性 HS 发病率更高（调整 IRR 1.60；95% CI 1.57-1.63）。PSM 后，患有 T2DM 的男性和女性接受去骨瓣减压术的频率明显低于非 T2DM 患者。T2DM 女性的院内死亡率（IHM）高于匹配的非 T2DM 女性（32.89%比 30.83%；p=0.037），男性之间没有差异。与匹配的 T2DM 女性相比，患有 T2DM 的男性行去骨瓣减压术的比例显著更高（5.81%比 3.33%；p<0.001）。T2DM 女性的 IHM 高于 T2DM 男性（32.89%比 28.28%；p<0.001）。使用多变量逻辑回归调整混杂因素后，与 T2DM 男性相比，T2DM 女性的死亡率风险增加 18%（比值比[OR]1.18；95% CI 1.07-1.29）。在伴有和不伴有 T2DM 的男性和女性中，住院前使用 OAC 和抗血小板药物与更高的 IHM 相关。
结论
T2DM 与 HS 的发病率较高有关，并且在两性中使用去骨瓣减压术的频率较低，但仅在女性中 IHM 较高。在经历过 HS 的 T2DM 患者中，性别差异明显，男性的发病率较高，去骨瓣减压术更频繁，而 IHM 较低。
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