探索性少数群体和性别少数群体中的中风风险因素及后果。
Exploring Stroke Risk Factors and Outcomes in Sexual and Gender Minority People.
作者信息
Diaz Michael Anthony, Rosendale Nicole
机构信息
Department of Neurology, University of California, San Francisco, San Francisco, CA.
出版信息
Neurol Clin Pract. 2023 Feb;13(1):e200106. doi: 10.1212/CPJ.0000000000200106. Epub 2023 Jan 18.
BACKGROUND AND OBJECTIVES
Cerebrovascular disease in sexual and gender minority (SGM) people remains poorly understood. Our primary objective was to describe the epidemiology and outcomes in a sample of SGM people with stroke. As a secondary objective, we compared this group with non-SGM people with stroke to assess for significant differences in risk factors or outcomes.
METHODS
This was a retrospective chart review study of SGM people admitted to an urban stroke center with primary diagnosis of stroke (ischemic or hemorrhagic). We evaluated stroke epidemiology and outcomes, summarizing with descriptive statistics. We then matched 1 SGM person to 3 non-SGM people by year of birth and year of diagnosis to compare demographics, risk factors, inpatient stroke metrics, and outcomes.
RESULTS
A total of 26 SGM people were included in the analysis: 20 (77%) had ischemic strokes, 5 (19%) intracerebral hemorrhages, and 1 (4%) subarachnoid hemorrhage. Compared with non-SGM people (n = 78), stroke subtypes showed a similar distribution (64 (82%) ischemic strokes, 12 (15%) intracerebral hemorrhages, 1 (1%) subarachnoid hemorrhage, and 1 nontraumatic subdural hematoma, > 0.05) but suspected ischemic stroke mechanisms had a different distribution (χ = 17.56, = 0.01). Traditional stroke risk factors were similar between the 2 groups. The SGM group seemed to have higher rates of nontraditional stroke factors, including HIV (31% vs 0%, < 0.01), syphilis (19% vs 0%, < 0.01), and hepatitis C (15% vs 5%, < 0.01) but were more likely to be tested for these risk factors (χ = 15.80, < 0.01; χ = 11.65, < 0.01; χ = 7.83, < 0.01, respectively). SGM people were more likely to have recurrent strokes (χ = 4.39, < 0.04) despite similar follow-up rates.
DISCUSSION
SGM people may have different risk factors, different mechanisms of stroke, and higher risk of recurrent stroke compared with non-SGM people. Standardized collection of sexual orientation and gender identity would enable larger studies to further understand disparities, leading to secondary prevention strategies.
背景与目的
性少数群体（SGM）的脑血管疾病仍未得到充分了解。我们的主要目标是描述一组SGM中风患者的流行病学特征及预后情况。作为次要目标，我们将该组与非SGM中风患者进行比较，以评估危险因素或预后方面的显著差异。
方法
这是一项对入住城市中风中心、初步诊断为中风（缺血性或出血性）的SGM患者进行的回顾性病历审查研究。我们评估了中风的流行病学特征及预后情况，并用描述性统计进行总结。然后，我们按出生年份和诊断年份将1名SGM患者与3名非SGM患者进行匹配，以比较人口统计学、危险因素、住院期间中风指标及预后情况。
结果
共有26名SGM患者纳入分析：20名（77%）为缺血性中风，5名（19%）为脑出血，1名（4%）为蛛网膜下腔出血。与非SGM患者（n = 78）相比，中风亚型分布相似（64名（82%）缺血性中风，12名（15%）脑出血，1名（1%）蛛网膜下腔出血，1名非创伤性硬膜下血肿，P>0.05），但疑似缺血性中风机制分布不同（χ² = 17.56，P = 0.01）。两组之间传统中风危险因素相似。SGM组非传统中风因素发生率似乎更高，包括艾滋病毒（31%对0%，P<0.01）、梅毒（19%对0%，P<0.01）和丙型肝炎（15%对5%，P<0.01），但更有可能接受这些危险因素检测（χ²分别为15.80，P<0.01；χ²为11.65，P<0.01；χ²为7.83，P<0.01）。尽管随访率相似，但SGM患者更易发生复发性中风（χ² = 4.39,P<0.04）。
讨论
与非SGM患者相比，SGM患者可能有不同的危险因素、不同的中风机制及更高的复发性中风风险。标准化收集性取向和性别认同将有助于开展更大规模研究，以进一步了解差异，从而制定二级预防策略。
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