Centro de Estudios Clínicos Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina Clínica Alemana Universidad del Desarrollo Santiago Chile.
Facultad de Ciencias de la Salud Blanquerna Universitat Ramon Llull Barcelona Spain.
J Am Heart Assoc. 2024 Aug 6;13(15):e035152. doi: 10.1161/JAHA.123.035152. Epub 2024 Jul 18.
Knowledge of local contextual sex differences in the profile and outcome for stroke can improve service delivery. We aimed to determine sex differences in the profile of patients with acute stroke and their associations with in-hospital death in the national hospital database of Chile.
We present a retrospective cohort based on the analysis of the 2019 Chilean database of Diagnosis-Related Groups, which represents 70% of the operational expenditure of the public health system. Random-effects multiple logistic regression models were used to determine independent associations of acute stroke (defined by main diagnosis [] codes) and in-hospital death, and reported with odds ratios (ORs) and 95% CIs. Of 1 048 575 hospital discharges, 15 535 were for patients with acute stroke (7074 [45.5%] in women), and 2438 (15.6%) of them died during hospitalization. Differences by sex in sociodemographic and clinical characteristics were identified for stroke and main subtypes. After fully adjusted model, women with ischemic stroke had lower in-hospital death (OR, 0.79 [95% CI, 0.69-0.91]) compared with men; other independent predictors included age per year increase (OR, 1.03 [95% CI, 1.03-1.04]), chronic kidney disease (OR, 1.47 [95% CI, 1.20-1.80]), atrial fibrillation (OR, 1.50 [95% CI, 1.26-1.80]), and other risk factors. Conversely, for intracerebral hemorrhage, women had a higher in-hospital mortality rate than men (OR, 1.19 [95% CI, 1.02-1.40]); other independent predictors included age per year increase (OR, 1.009 [95% CI, 1.003-1.01]), chronic kidney disease (OR, 1.55 [95% CI, 1.23-1.97]), oral anticoagulant use (OR, 1.88 [95% CI, 1.37-2.58]), and other risk factors.
Sex differences in characteristics and in-hospital death of hospitalized patients exist for acute stroke in Chile. In-hospital death is higher for acute ischemic stroke in men and higher for intracerebral hemorrhage in women. Future research is needed to better identify contributing factors.
了解当地语境下与中风相关的性别差异，有助于改善服务的提供。本研究旨在智利国家医院数据库中，确定急性中风患者的特征以及其与院内死亡之间的性别差异。
本研究为回顾性队列研究，分析了 2019 年智利的诊断相关组数据库，该数据库涵盖了公共卫生系统运营支出的 70%。采用随机效应多逻辑回归模型，确定急性中风（主要诊断[]代码定义）与院内死亡的独立关联，并以比值比（OR）及其 95%置信区间（CI）表示。在 1048575 例出院患者中，有 15535 例（7074 例[45.5%]为女性）为急性中风患者，其中 2438 例（15.6%）在住院期间死亡。本研究识别了与中风和主要亚型相关的性别差异在社会人口统计学和临床特征方面的差异。在完全调整后的模型中，与男性相比，女性缺血性中风患者的院内死亡率较低（OR，0.79 [95%CI，0.69-0.91]）；其他独立预测因子包括每年年龄增长（OR，1.03 [95%CI，1.03-1.04]）、慢性肾脏病（OR，1.47 [95%CI，1.20-1.80]）、心房颤动（OR，1.50 [95%CI，1.26-1.80]）和其他危险因素。相反，对于脑出血，女性的院内死亡率高于男性（OR，1.19 [95%CI，1.02-1.40]）；其他独立预测因子包括每年年龄增长（OR，1.009 [95%CI，1.003-1.01]）、慢性肾脏病（OR，1.55 [95%CI，1.23-1.97]）、口服抗凝剂使用（OR，1.88 [95%CI，1.37-2.58]）和其他危险因素。
智利急性中风住院患者的特征和院内死亡率存在性别差异。男性急性缺血性中风患者的院内死亡率较高，女性脑出血患者的院内死亡率较高。需要进一步研究以更好地确定促成因素。
