Mascarenhas Rinita, Gandhi Dorcas B C, Sesgundo Jaime Angeles, Babu Veena, Mani Vinita Elizabeth, Sebastian Ivy Anne
Department of Neurology, Christian Medical College and Hospital, Ludhiana, India.
College of Physiotherapy, Christian Medical College and Hospital Ludhiana, Ludhiana, India.
Cerebrovasc Dis. 2024 Oct 14:1-9. doi: 10.1159/000542010.
South Asia and Southeast Asia account for more than 40% of the global stroke burden, with differences in stroke risk factors, mortality, and outcomes compared to high-income countries. Sociocultural norms compound the preexisting biological risk differences, resulting in a disproportionate burden of stroke in women in this region. This review summarizes the sex and gender differences across the stroke care continuum in South Asia and Southeast Asia over the past 20 years.
Despite a higher incidence of stroke in men than women in South and Southeast Asia, women have greater stroke severity and poorer outcomes after stroke. Higher levels of premorbid disability and poor physical health at baseline may be contributory. There is a high prevalence of vascular risk factors such as hypertension, dyslipidemia, cardiac sources of embolism, as well as metabolic syndrome and insulin resistance, among the women in this region. Smoking is uncommon among women; however, other forms of smokeless tobacco, such as tobacco leaf and betel nut chewing, are more prevalent, especially in the rural areas in these countries. Women are more likely to have delayed presentations to the hospital due to untimely recognition of stroke symptoms; however, with regards to door-to-needle times or intravenous thrombolysis (IVT) rates, we found equivocal data. Wide gaps exist in stroke awareness and healthcare-seeking behaviors, with women more commonly opting for public hospitals and low-cost wards, more likely to discontinue treatment, and less likely to adhere to poststroke rehabilitation.
This review exposes the gender lacunae in stroke service provision across South Asia and Southeast Asia while acknowledging the many knowledge gaps in our understanding. Although the biological risk differences are non-modifiable, educational, policy, and economic measures to mitigate sociocultural barriers are much needed in the region. Sound epidemiological data are needed from more countries to better understand these differences and bridge this gap. It is imperative to advocate and implement policies and programs for stroke care viable for women, cognizant of the gender and cost bias, as well as the interplay of social and cultural structures specific to the regions.
南亚和东南亚地区的中风负担占全球的40%以上，与高收入国家相比，中风风险因素、死亡率和预后存在差异。社会文化规范加剧了原有的生物学风险差异，导致该地区女性中风负担过重。本综述总结了过去20年南亚和东南亚地区中风护理连续过程中的性别差异。
尽管南亚和东南亚地区男性中风发病率高于女性，但女性中风严重程度更高，中风后预后更差。病前残疾水平较高和基线时身体健康状况较差可能是原因之一。该地区女性中血管危险因素如高血压、血脂异常、心脏栓塞源以及代谢综合征和胰岛素抵抗的患病率较高。女性吸烟并不常见；然而，其他形式的无烟烟草，如嚼烟叶和槟榔，更为普遍，尤其是在这些国家的农村地区。由于中风症状未得到及时识别，女性更有可能延迟就医；然而，关于门到针时间或静脉溶栓（IVT）率，我们发现数据并不明确。中风认知和就医行为存在巨大差距，女性更常选择公立医院和低成本病房，更有可能中断治疗，且不太可能坚持中风后康复治疗。
本综述揭示了南亚和东南亚地区中风服务提供中的性别差距，同时也承认我们在理解上存在许多知识空白。尽管生物学风险差异无法改变，但该地区迫切需要采取教育、政策和经济措施来减轻社会文化障碍。需要更多国家提供可靠的流行病学数据，以更好地理解这些差异并弥合这一差距。必须倡导并实施对女性可行的中风护理政策和项目，同时认识到性别和成本偏见以及该地区特定的社会和文化结构的相互作用。
