Chen Huanwen, Khunte Mihir, Colasurdo Marco, Majmundar Shyam, Payabvash Seyedmehdi, Chaturvedi Seemant, Malhotra Ajay, Gandhi Dheeraj
Department of Neurology, MedStar Georgetown University Hospital, Washington, DC (H.C.).
Division of Interventional Neuroradiology, Department of Radiology (H.C., S.M., D.G.), University of Maryland Medical Center, Baltimore.
Stroke. 2025 Feb;56(2):285-293. doi: 10.1161/STROKEAHA.124.049278. Epub 2025 Jan 27.
Sex-specific differences in stroke risk factors, clinical presentation, and outcomes are well documented. However, little is known about real-world differences in transient ischemic attack (TIA) hospitalizations and outcomes between men and women.
This was a retrospective cohort study of the 2016 to 2021 Nationwide Readmissions Database in the United States. Adult patients hospitalized for TIA were included. Annual incidences of TIA hospitalizations for men and women were calculated using the US Census Bureau data. Primary end points were 90-day readmission for ischemic stroke or hemorrhage and compared between men and women. Demographics and comorbidities were captured and used to adjust for confounders using propensity score matching and logistic regression models.
A total of 588 499 patients were identified; 326 794 (55.5%) were women. The estimated annual incidence of TIA hospitalizations was 42.4 (95% CI, 26.0-58.9) per 100 000 women and 36.2 (95% CI, 23.5-48.9) per 100 000 men (relative risk, 1.17 [95% CI, 1.13-1.21]; <0.001). Overall, women were older, had higher rates of headache and psychiatric comorbidities, and had lower rates of vascular risk factors compared with men. Women were significantly less likely to be readmitted for ischemic stroke (hazard ratio, 0.86 [95% CI, 0.79-0.93]; <0.001) and more likely to be readmitted for hemorrhage (hazard ratio, 1.12 [95% CI, 1.04-1.20]; <0.001), with similar rates of antithrombotic use at the time of readmissions (>0.05). Compared with ischemic stroke, hemorrhage readmissions were significantly associated with lower odds of home discharge (odds ratio, 0.83 [95% CI, 0.76-0.91]; <0.001) and higher odds of death (odds ratio, 3.01 [95% CI, 2.35-3.87]; <0.001).
Women have a higher incidence of TIA hospitalizations than men, which may be due to higher rates of nonischemic causes of transient neurological symptoms as evidenced by differences in baseline characteristics and lower rates of subsequent ischemic stroke. Future studies are needed to better characterize transient neurological symptoms in women to avoid excess hospitalizations and unnecessary treatments that may increase hemorrhage risk.
中风危险因素、临床表现及预后方面的性别差异已有充分记录。然而，关于男性和女性短暂性脑缺血发作（TIA）住院情况及预后的实际差异，人们知之甚少。
这是一项对2016年至2021年美国全国再入院数据库的回顾性队列研究。纳入因TIA住院的成年患者。利用美国人口普查局数据计算男性和女性TIA住院的年发病率。主要终点是缺血性中风或出血性中风的90天再入院率，并在男性和女性之间进行比较。记录人口统计学和合并症情况，并使用倾向评分匹配和逻辑回归模型对混杂因素进行调整。
共识别出588499例患者；其中326794例（55.5%）为女性。估计女性TIA住院的年发病率为每10万女性中有42.4例（95%CI，26.0 - 58.9），男性为每10万男性中有36.2例（95%CI，23.5 - 48.9）（相对风险，1.17 [95%CI，1.13 - 1.21]；P<0.001）。总体而言，与男性相比，女性年龄更大，头痛和精神疾病合并症发生率更高，血管危险因素发生率更低。女性因缺血性中风再次入院的可能性显著更低（风险比，0.86 [95%CI，0.79 - 0.93]；P<0.001），因出血性中风再次入院的可能性更高（风险比，1.12 [95%CI，1.04 - 1.20]；P<0.001），再次入院时抗血栓药物使用比例相似（P>0.05）。与缺血性中风相比，出血性中风再入院与出院回家几率较低（优势比，0.83 [95%CI，0.76 - 0.91]；P<0.001）和死亡几率较高（优势比，3.01 [95%CI，2.35 - 3.87]；P<0.001）显著相关。
女性TIA住院发病率高于男性，这可能是由于短暂性神经症状的非缺血性病因发生率较高，这在基线特征差异以及后续缺血性中风发生率较低中得到体现。需要进一步研究以更好地描述女性的短暂性神经症状，避免过度住院和可能增加出血风险的不必要治疗。
