Asikainen Aleksanteri, Korja Miikka, Kaprio Jaakko, Rautalin Ilari
Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland,
Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
Neuroepidemiology. 2024;58(6):412-425. doi: 10.1159/000538562. Epub 2024 Apr 10.
Aneurysmal subarachnoid hemorrhage (SAH) is more common in women than in men, contrary to most cardiovascular diseases. However, it is unclear whether the case fatality rate (CFR) of SAH also differs by sex. Thus, we performed a systematic review to address the relationship between sex and SAH CFRs.
We conducted a systematic literature search in PubMed, Scopus, and Cochrane library databases. We focused on population-based studies that included both nonhospitalized and hospitalized SAHs and had either reported 1-month (28-31 day) SAH CFRs separately for men and women or calculated risk estimates for SAH CFR by sex. For quality classification, we used the Cochrane Collaboration Handbook and Critical Appraisal Skills Program guidelines. We pooled the study cohorts and calculated relative risk ratios (RRs) with 95% confidence intervals (CIs) for SAH death between women and men using a random-effects meta-analysis model.
The literature search yielded 5,592 initial publications, of which 33 study cohorts were included in the final review. Of the 33 study cohorts, only three reported significant sex differences, although the findings were contradictory. In the pooled analysis of all 53,141 SAH cases (60.3% women) from 26 countries, the 1-month CFR did not differ (RR = 0.99 [95% CI: 0.93-1.05]) between women (35.5%) and men (35.0%). According to our risk-of-bias evaluation, all 33 study cohorts were categorized as low quality. The most important sources of bias risks were related to the absence of proper confounding control (all 33 study cohorts), insufficient sample size (27 of 33 study cohorts), and poor/unclear diagnostic accuracy (27 of 33 study cohorts).
Contrary to SAH incidence rates, the SAH CFRs do not seem to differ between men and women. However, since none of the studies were specifically designed to examine the sex differences in SAH CFRs, future studies on the topic are warranted.
与大多数心血管疾病相反，动脉瘤性蛛网膜下腔出血（SAH）在女性中比在男性中更为常见。然而，目前尚不清楚SAH的病死率（CFR）是否也因性别而异。因此，我们进行了一项系统评价，以探讨性别与SAH病死率之间的关系。
我们在PubMed、Scopus和Cochrane图书馆数据库中进行了系统的文献检索。我们重点关注基于人群的研究，这些研究包括非住院和住院的SAH病例，并且要么分别报告了男性和女性的1个月（28 - 31天）SAH病死率，要么按性别计算了SAH病死率的风险估计值。对于质量分类，我们使用了Cochrane协作手册和批判性评价技能计划指南。我们汇总了研究队列，并使用随机效应荟萃分析模型计算了女性和男性之间SAH死亡的相对风险比（RRs）及95%置信区间（CIs）。
文献检索共获得5592篇初始出版物，其中33个研究队列被纳入最终评价。在这33个研究队列中，只有3个报告了显著的性别差异，尽管研究结果相互矛盾。在对来自26个国家的所有53141例SAH病例（60.3%为女性）进行的汇总分析中，女性（35.5%）和男性（35.0%）的1个月病死率没有差异（RR = 0.99 [95% CI：0.93 - 1.05]）。根据我们的偏倚风险评估，所有33个研究队列均被归类为低质量。偏倚风险的最重要来源与缺乏适当的混杂因素控制（所有33个研究队列）、样本量不足（33个研究队列中的27个）以及诊断准确性差/不明确（33个研究队列中的27个）有关。
与SAH发病率不同，SAH病死率似乎在男性和女性之间没有差异。然而，由于没有一项研究是专门设计用于研究SAH病死率的性别差异，因此有必要对该主题进行进一步的研究。
