Abdel-Fattah Abdel-Rahman, Pana Tiberiu A, Tiamkao Somsak, Sawanyawisuth Kittisak, Kasemsap Narongrit, Mamas Mamas A, Myint Phyo K
Ageing Clinical and Experimental Research (ACER) Team, Institute of Applied Health Sciences, School of Medicine, Medical Sciences & Nutrition, University of Aberdeen, Foresterhill, Aberdeen, AB25 2ZD, Scotland, UK.
Ageing Clinical and Experimental Research (ACER) Team, Institute of Applied Health Sciences, School of Medicine, Medical Sciences & Nutrition, University of Aberdeen, Foresterhill, Aberdeen, AB25 2ZD, Scotland, UK.
Ann Cardiol Angeiol (Paris). 2023 Feb;72(1):1-7. doi: 10.1016/j.ancard.2022.11.003. Epub 2022 Nov 23.
Over half of the growing global stroke-mortality burden is accounted for by the East-Asian-subcontinent alone. Sex differences in stroke-mortality in the Asian population is yet to be assessed in the literature. We aimed to assess the sex-differences in mortality following stroke in a large cohort of Thai-patients.
All stroke admissions between 2004-2015 were included from the Thailand public-health-insurance-database. The association between sex and mortality was assessed in-hospital, at 1 month, 1 year and 5 years, using multivariable Cox-regressions, separately for ischaemic-stroke (IS), haemorrhagic-stroke (HS) and stroke-of-undetermined-type(SUT), adjusting for confounders.
608,890 patients were included: 370,527 patients with IS(60.9%), 173,236 with HS(28.5%) and 65,127 with SUT(10.6%). Women were older than men in all three groups and had higher prevalence of comorbidities. Adjusted hazard-ratios(HRs) of mortality showed women had higher mortality post-IS compared to men (in-hospital: HR: 1.20; 95% CI: 1.17-1.23; 1 month: HR: 1.17; 95% CI: 1.15-1.20; 1 year: HR: 1.10; 95% CI: 1.09-1.12 and 5 years: HR: 1.02; 95% CI: 1.01-1.03). Women also had higher mortality after HS (in-hospital: HR: 1.02; 95% CI: 1.00-1.04; 1 month: HR: 1.08; 95% CI: 1.06-1.10; 1 year: HR: 1.04; 95% CI: 1.03-1.06 and 5 years: HR: 1.09; 95% CI: 1.08-1.11), and SUT (in-hospital: HR: 1.04; 95% CI: 1.03-1.06; 1 month: HR: 1.20; 95% CI: 1.14-1.27; 1 year: HR: 1.14; 95% CI: 1.09-1.18 and 5 years: HR: 1.06; 95% CI: 1.03-1.10).
Compared to men, women were older at time of stroke-diagnosis and had higher burden of stroke risk-factors. Women also had higher mortality after stroke regardless of stroke-type or duration since stroke-onset. Post-IS, excess stroke-mortality in women was greatest during the in-hospital period, whereas excess stroke-mortality increased with time in women who had HS. No clear relationship was found between duration since stroke-onset and mortality in patients who had SUT.
在全球不断增长的中风死亡负担中，仅东亚次大陆就占了一半以上。亚洲人群中风死亡率的性别差异在文献中尚未得到评估。我们旨在评估一大群泰国患者中风后死亡率的性别差异。
纳入泰国公共医疗保险数据库中2004年至2015年期间所有中风住院病例。使用多变量Cox回归分别对缺血性中风（IS）、出血性中风（HS）和未定型中风（SUT）在住院时、1个月、1年和5年时评估性别与死亡率之间的关联，并对混杂因素进行调整。
共纳入608,890例患者：370,527例缺血性中风患者（60.9%），173,236例出血性中风患者（28.5%）和65,127例未定型中风患者（10.6%）。在所有三组中，女性年龄均大于男性，且合并症患病率更高。调整后的死亡率风险比（HRs）显示，与男性相比，女性缺血性中风后的死亡率更高（住院时：HR：1.20；95%置信区间：1.17 - 1.23；1个月时：HR：1.17；95%置信区间：1.15 - 1.20；1年时：HR：1.10；95%置信区间：1.09 - 1.12；5年时：HR：1.02；95%置信区间：1.01 - 1.03）。女性出血性中风后的死亡率也更高（住院时：HR：1.02；95%置信区间：1.00 - 1.04；1个月时：HR：1.08；95%置信区间：1.06 - 1.10；1年时：HR：1.04；95%置信区间：1.03 - 1.06；5年时：HR：1.09；95%置信区间：1.08 - 1.11），未定型中风后的死亡率同样更高（住院时：HR：1.04；95%置信区间：1.03 - 1.06；1个月时：HR：1.20；95%置信区间：1.14 - 1.27；1年时：HR：1.14；95%置信区间：1.09 - 1.18；5年时：HR：1.06；95%置信区间：1.03 - 1.10）。
与男性相比，女性中风诊断时年龄更大，中风风险因素负担更高。无论中风类型或中风发作后的持续时间如何，女性中风后的死亡率也更高。缺血性中风后，女性在住院期间的额外中风死亡率最高，而出血性中风女性的额外中风死亡率随时间增加。未定型中风患者中风发作后的持续时间与死亡率之间未发现明确关系。
