School of Population Health and Environmental Sciences (M.X., C.C.C., A.R., C.W., M.D.L.O., A.D.), King's College London, United Kingdom.
School of Immunology and Microbial Sciences (A.A.V.), King's College London, United Kingdom.
Stroke. 2022 Oct;53(10):3072-3081. doi: 10.1161/STROKEAHA.121.037829. Epub 2022 Jun 23.
Limited data are available on sex-related disparities in long-term outcomes after stroke. We estimated sex differences in various stroke long-term outcomes among survivors after stroke in a prospective 25-year follow-up study.
Individuals recruited to the South London Stroke Register, an ongoing multi-ethnic urban-based population stroke register, from 1995 onward were included in the analyses (n=6687). The outcomes were death, subsequent stroke, activity of daily living, instrumental activity of daily living, cognitive impairment, depression, anxiety, and health-related quality of life. Kaplan-Meier curves were generated for mortality, stroke recurrence, and recurrence-free survival by sex and Cox proportional hazards model used to model sex differences up to 25 years. Generalized estimating equation were used to model sex differences in risk of self-reported stroke outcomes over 10 years poststroke outcomes, adjusting for age, preexisting activity of daily living, case-mix, stroke subtypes, and other potential confounding risk factors.
There were 49% women (mean age, 72 years; SD, 15.6) and 51% men (mean age, 67 years; SD, 14.3) in 6687 participants. Compared with men, women had 9% (95% CI, 3%-15%) lower covariate-adjusted risk of death and 6% (0%-13%) lower risk of stroke recurrence or death. Generally, women had significantly poorer outcomes in activity of daily living and anxiety than men, and the sex differences persisted to up to 5 years after stroke. Women also had poorer health-related quality of life in physical (β=-2.06 [95% CI, -3.01 to -1.10]) and mental domains (β=-1.48 [95% CI, -2.44 to -0.52]). Although not significant, there was a suggestive trend for poorer outcomes in cognitive impairment and depression in women. No significant difference in stroke recurrence were found between men and women.
Female patients with stroke tended to have better covariate-adjusted survival but poorer outcomes among survivors than male patients, with deficits persisting to up to 5 years poststroke.
关于中风后长期预后的性别差异，目前的数据有限。我们在一项前瞻性的 25 年随访研究中，评估了中风后幸存者各种中风长期预后的性别差异。
从 1995 年开始，我们将招募到南伦敦中风登记处（一个正在进行的多民族城市人口中风登记处）的个体纳入分析（n=6687）。结果是死亡、随后的中风、日常生活活动、工具性日常生活活动、认知障碍、抑郁、焦虑和健康相关生活质量。根据性别生成死亡率、中风复发和无复发生存率的 Kaplan-Meier 曲线，并使用 Cox 比例风险模型在 25 年内对性别差异进行建模。使用广义估计方程在 10 年的中风后结果上对自我报告的中风结果的风险进行建模，调整年龄、预先存在的日常生活活动、病例组合、中风亚型和其他潜在的混杂风险因素。
在 6687 名参与者中，女性占 49%（平均年龄 72 岁，标准差 15.6），男性占 51%（平均年龄 67 岁，标准差 14.3）。与男性相比，女性的死亡调整后风险降低 9%（95%置信区间，3%-15%），中风复发或死亡的风险降低 6%（0%-13%）。一般来说，女性的日常生活活动和焦虑结局明显比男性差，性别差异在中风后长达 5 年仍持续存在。女性在身体（β=-2.06[95%置信区间，-3.01 至-1.10]）和心理领域（β=-1.48[95%置信区间，-2.44 至-0.52]）的健康相关生活质量也较差。虽然不显著，但女性在认知障碍和抑郁方面的结局较差存在提示性趋势。在男性和女性之间未发现中风复发有显著差异。
与男性患者相比，中风女性患者的调整后生存情况往往更好，但幸存者的结局更差，这种缺陷持续到中风后长达 5 年。
