Neurosurgery, Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
Front Public Health. 2024 Oct 16;12:1434742. doi: 10.3389/fpubh.2024.1434742. eCollection 2024.
There is a difference in the incidence of spontaneous subarachnoid hemorrhage (SAH) between sexes, with the majority of cases occurring in female patients. Although this phenomenon has been studied from a medical perspective, the reasons for the predominance of female cases are still unclear. Non-medical factors, such as a patient's socioeconomic situation, can differ between female and male patients, with health implications. The aim of the study was to identify socioeconomic profiles for both sexes that may be vulnerable to developing SAH. This information could potentially be used for active preventive health efforts.
This study was based on a 7-year consecutive cohort of 890 patients with SAH treated at Uppsala University Hospital, along with a sex- and age-matched 5:1 control group from Statistics Sweden. The collected information included demographic data, income that was analyzed through "earnings" (EAs), which is defined as the sum of income and other economic compensations related to work, and "disposable income" (DI), which is the net amount that an individual can use. Pension and sickness-related absence from work were measured using early pension (EP), old age pension (OAP), sickness absence (SA), and disability pension (DP). Univariate and multivariate analyses were used.
Among the women, the socioeconomic risk profile for SAH included lower education, unemployment, being registered as living single, residing in a sparsely populated municipality, and increased age. For the men, the risk profile included residing in a sparsely populated municipality and changes in civil status. Both women and men with SAH had lower EAs and DI compared to the controls. Notably, a significantly higher proportion of the women with SAH received DP compared to the controls.
Residing in a sparsely populated area was associated with an increased risk for SAH for both women and men. The women with SAH were more economically vulnerable, whereas the men faced a different type of vulnerability related to changes in civil status. We suggest that healthcare organizations use this information to identify individuals at risk and actively implement preventive measures according to stroke guidelines for both groups.
自发性蛛网膜下腔出血（SAH）的发病率在性别之间存在差异，大多数病例发生在女性患者中。尽管这一现象已经从医学角度进行了研究，但女性病例居多的原因仍不清楚。除了医学因素之外，患者的社会经济状况等非医学因素在男女患者之间可能存在差异，这对健康有影响。本研究的目的是确定可能易患 SAH 的男女两性的社会经济特征。这些信息可能有助于进行积极的预防性健康工作。
本研究基于在乌普萨拉大学医院接受治疗的 890 例连续 7 年的 SAH 患者队列，以及来自瑞典统计局的性别和年龄匹配的 5:1 对照组。收集的信息包括人口统计学数据、收入（EA），EA 定义为收入和与工作相关的其他经济补偿的总和，以及“可支配收入”（DI），即个人可使用的净金额。使用提前养老金（EP）、老年养老金（OAP）、病假（SA）和残疾养老金（DP）来衡量养老金和与疾病相关的工作缺勤情况。采用单变量和多变量分析。
在女性中，SAH 的社会经济风险因素包括教育程度较低、失业、被登记为独居、居住在人口稀少的市镇以及年龄较大。对于男性，风险因素包括居住在人口稀少的市镇和婚姻状况的变化。与对照组相比，SAH 患者的 EA 和 DI 均较低。值得注意的是，与对照组相比，SAH 女性患者中 DP 的比例显著更高。
居住在人口稀少的地区与女性和男性的 SAH 风险增加相关。SAH 女性患者在经济上更脆弱，而男性则面临与婚姻状况变化相关的不同类型的脆弱性。我们建议医疗保健组织利用这些信息来识别高危人群，并根据中风指南为两个群体积极实施预防措施。
