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Tsai CF, Wang YH, Teng NC, Yip PK, Chen LK. Incidence, subtypes, sex differences and trends of stroke in Taiwan. PLoS One 2022; 17:e0277296. [PMID: 36383604 PMCID: PMC9668115 DOI: 10.1371/journal.pone.0277296] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 10/24/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Chinese populations have been reported higher incidence of all strokes and intracerebral hemorrhage. However, few large-scale studies have evaluated changes of stroke epidemiology in the 21st century. METHODS We explored the rates of incidence of all first-ever strokes, subtypes, and 1-month case fatality by using data from the Taiwan National Health Insurance Research Database since 2004. Also, we investigated sex differences in stroke. Time-trend analysis was performed for incidence and case fatality rates of all strokes and subtypes in both sexes. RESULTS The age-adjusted incidence of all strokes per 100,000 person-years decreased by 16%, from 251 (95% confidence interval [CI] 249-253) in 2004 to 210 (95% CI 209-212) in 2011 (p<0.001); it was always higher in Chinese men than in women. Among pathological subtypes, the incidence of intracerebral hemorrhage markedly decreased by 26% over the years (p<0.001), while that of ischemic stroke slightly decreased by 8%. However, when stratified by sex, the incidence of ischemic stroke decreased significantly in only women, not in men (men: p = 0.399, women: p = 0.004). Regarding the incidence of subarachnoid hemorrhage, it remained unchanged. Furthermore, the rate of 1-month case fatality decreased significantly for all strokes in both sexes (p<0.001). CONCLUSIONS In Taiwan, the incidence rate of first-ever stroke decreased in both Chinese men and women in the early 21st century. Men had a higher incidence rate than women. Furthermore, a marked decrease was noted in the incidence of intracerebral hemorrhage, while a slight decrease was noted in that of ischemic stroke; however, the decreased incidence of ischemic stroke was significant in only women.
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Affiliation(s)
- Chung-Fen Tsai
- Division of Neurology, Cardinal Tien Hospital and School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
- * E-mail: (CFT); (LKC)
| | - Ya-Hui Wang
- Medical Research Center, Cardinal Tien Hospital and School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Nai-Chi Teng
- Institute of Population Health Sciences, National Health Research Institutes, New Taipei City, Taiwan
| | - Ping-Keung Yip
- Division of Neurology, Cardinal Tien Hospital and School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Li-Kwang Chen
- Institute of Population Health Sciences, National Health Research Institutes, New Taipei City, Taiwan
- * E-mail: (CFT); (LKC)
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Scott CA, Li L, Rothwell PM. Diverging Temporal Trends in Stroke Incidence in Younger vs Older People: A Systematic Review and Meta-analysis. JAMA Neurol 2022; 79:1036-1048. [PMID: 35943738 PMCID: PMC9364236 DOI: 10.1001/jamaneurol.2022.1520] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 04/15/2022] [Indexed: 12/25/2022]
Abstract
Importance Overall stroke incidence is falling in high-income countries, but data on time trends in incidence of young stroke (ie, stroke in individuals younger than 55 years) are conflicting. An age-specific divergence in incidence, with less favorable trends at younger vs older ages, might be a more consistent underlying finding across studies. Objective To compare temporal trends in incidence of stroke at younger vs older ages in high-income countries. Data Sources PubMed and EMBASE were searched from inception to February 2022. One additional population-based study (Oxford Vascular Study) was also included. Study Selection Studies reporting age-specific stroke incidence in high-income countries at more than 1 time point. Data Extraction and Synthesis For all retrieved studies, 2 authors independently reviewed the full text against the inclusion criteria to establish their eligibility. Meta-analysis was performed with the inverse variance-weighted random-effects model. Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline was followed. Main Outcomes and Measures The main outcome was age-specific divergence (<55 vs ≥55 years) in temporal trends in stroke incidence (relative temporal rate ratio [RTTR]) in studies extending to at least 2000. RTTRs were calculated for each study and pooled by random-effects meta-analysis, with stratification by administrative vs prospective population-based methodology, sex, stroke subtype (ischemic vs intracerebral hemorrhage vs subarachnoid hemorrhage) and geographical region. Results Among 50 studies in 20 countries, 26 (13 prospective population-based and 13 administrative studies) reported data allowing calculation of the RTTR for stroke incidence at younger vs older ages across 2 or more periods, the latest extending beyond 2000. Reported trends in absolute incidence of young individuals with stroke were heterogeneous, but all studies showed a less favorable trend in incidence at younger vs older ages (pooled RTTR = 1.57 [95% CI, 1.42-1.74]). The overall RTTR was consistent by stroke subtype (ischemic, 1.62 [95% CI, 1.44-1.83]; intracerebral hemorrhage, 1.32 [95% CI, 0.91-1.92]; subarachnoid hemorrhage, 1.54 [95% CI, 1.00-2.35]); and by sex (men, 1.46 [95% CI, 1.34-1.60]; women, 1.41 [95% CI, 1.28-1.55]) but was greater in studies reporting trends solely after 2000 (1.51 [95% CI, 1.30-1.70]) vs solely before (1.18 [95% CI, 1.12-1.24]) and was highest in population-based studies in which the most recent reported period of ascertainment started after 2010 (1.87 [95% CI, 1.55-2.27]). Conclusions and Relevance Temporal trends in stroke incidence are diverging by age in high-income countries, with less favorable trends at younger vs older ages, highlighting the urgent need to better understand etiology and prevention of stroke at younger ages.
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Affiliation(s)
- Catherine A. Scott
- Wolfson Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neuroscience, University of Oxford, Oxford, United Kingdom
| | - Linxin Li
- Wolfson Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neuroscience, University of Oxford, Oxford, United Kingdom
| | - Peter M. Rothwell
- Wolfson Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neuroscience, University of Oxford, Oxford, United Kingdom
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Abdel-Fattah AR, Pana TA, Smith TO, Pasdar Z, Aslam M, Mamas MA, Myint PK. Gender differences in mortality of hospitalised stroke patients. Systematic review and meta-analysis. Clin Neurol Neurosurg 2022; 220:107359. [PMID: 35835023 DOI: 10.1016/j.clineuro.2022.107359] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 06/22/2022] [Accepted: 07/03/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Gender differences in mortality after stroke remains unclear in the current literature. We therefore aimed to systematically review the gender differences in mortality up to five years after ischaemic (IS) or haemorrhagic stroke (HS) to address this evidence gap. METHODS The literature was systematically searched using Ovid EMBASE, Ovid Medline, and Web of Science databases, from inception-November 2021. The quality of evidence was appraised using the CASP Cohort-study checklist. Unadjusted and adjusted odds and hazard ratios were meta-analysed, separately for IS and HS and a subgroup analysis of age-stratified mortality data was conducted. RESULTS Forty-one studies were included (n = 8,128,700; mean-age 68.5 yrs; 47.1% female). 37 studies were included in meta-analysis (n = 8, 8008, 110). Compared to men, women who had an IS had lower mortality risk in-hospital (0.94; 95%CI 0.91-0.97), at one-month (0.87; 95%CI 0.77-0.98), 12-months (0.94; 95%CI 0.91-0.98) and five-years (0.93 95%CI 0.90-0.96). The subgroup analysis showed that this gender difference in mortality was present in women ≥ 70 years up to one-month post-IS (in-hospital: 0.94; 95%CI 0.91-0.97; one-month: 0.87; 95% CI 0.77-0.98), however, in women < 70 years this difference was no longer present. Nevertheless, analysis of crude data showed women were at higher risk of mortality in-hospital, at 12-months and five-years (in-hospital: 1.05; 95%CI 1.03-1.07, 12-months: 1.10; 95%CI 1.06-1.14, five-years: 1.06; 95%CI 1.02-1.10). After HS, women had higher mortality risk in-hospital (1.03; 95%CI 1.01-1.04) however, no gender differences were found post-discharge. CONCLUSION The gender differences in post-stroke mortality differ by stroke type, age group and follow-up. Crude stroke mortality in women is higher than in men and this appears to be driven by pre-existing comorbidities. In adjusted models, women have a lower mortality risk following IS, independent of duration of follow-up. After HS, women had higher mortality in hospital however, no gender differences after hospital discharge were found.
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Affiliation(s)
- Abdel-Rahman Abdel-Fattah
- Ageing Clinical and Experimental Research (ACER) Team, Institute of Applied Health Sciences, School of Medicine, Medical Sciences & Nutrition, University of Aberdeen, Aberdeen, UK.
| | - Tiberiu A Pana
- Ageing Clinical and Experimental Research (ACER) Team, Institute of Applied Health Sciences, School of Medicine, Medical Sciences & Nutrition, University of Aberdeen, Aberdeen, UK
| | - Toby O Smith
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Zahra Pasdar
- Ageing Clinical and Experimental Research (ACER) Team, Institute of Applied Health Sciences, School of Medicine, Medical Sciences & Nutrition, University of Aberdeen, Aberdeen, UK
| | - Maha Aslam
- Ageing Clinical and Experimental Research (ACER) Team, Institute of Applied Health Sciences, School of Medicine, Medical Sciences & Nutrition, University of Aberdeen, Aberdeen, UK
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, Stoke-on-Trent, UK
| | - Phyo K Myint
- Ageing Clinical and Experimental Research (ACER) Team, Institute of Applied Health Sciences, School of Medicine, Medical Sciences & Nutrition, University of Aberdeen, Aberdeen, UK
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Yung NCL, Wong CSM, Chan JKN, Or PCF, Chen EYH, Chang WC. Mortality in patients with schizophrenia admitted for incident ischemic stroke: A population-based cohort study. Eur Neuropsychopharmacol 2020; 31:152-157. [PMID: 31883653 DOI: 10.1016/j.euroneuro.2019.12.107] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 11/21/2019] [Accepted: 12/08/2019] [Indexed: 01/03/2023]
Abstract
Evidence shows that schizophrenia is associated with increased incidence of stroke. However, relationship between schizophrenia and short-term mortality risk is understudied, and mixed findings were observed. In this retrospective population-based cohort study, we identified individuals admitted for incident ischemic stroke between 2006 and 2016 using a territory-wide electronic medical record database of public healthcare system in Hong Kong to examine 30-day and 1-year mortality rates in 817 schizophrenia patients compared with 8170 patients without psychotic disorder (10:1 matched to schizophrenia patients on demographics, treatment sites and calendar-period for index admission). Multivariate regression analyses adjusting for medical comorbidities revealed that schizophrenia patients experienced elevated 1-year (16.9% vs 12.1%; p < 0.001) and 30-day mortality (7.2% vs 5.3%; p = 0.053) relative to control group. Additional age- and gender-stratified analyses revealed even more pronounced effect of schizophrenia on raised mortality risk, as indicated by higher odds, in younger-age (<65 years) group and men. Our results indicate that schizophrenia is associated with heightened short-term mortality following incident ischemic stroke. Further research is warranted to identify factors contributing to excess post-stroke deaths among schizophrenia patients to facilitate development of effective interventions for mortality risk reduction.
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Affiliation(s)
| | - Corine Sau Man Wong
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Joe Kwun Nam Chan
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Philip Chi Fai Or
- Department of Psychiatry, Queen Mary Hospital, Hospital Authority, Hong Kong
| | - Eric Yu Hai Chen
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Hong Kong; State Key Laboratory of Brain and Cognitive Sciences, the University of Hong Kong, Hong Kong
| | - Wing Chung Chang
- Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, Hong Kong; State Key Laboratory of Brain and Cognitive Sciences, the University of Hong Kong, Hong Kong.
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Yan F, Yi Z, Hua Y, Shen Y, Li M, Ding Y, Chandra A, Ji X, Yue W. Predictors of mortality and recurrent stroke within five years of intracerebral hemorrhage. Neurol Res 2018; 40:466-472. [PMID: 30134784 DOI: 10.1080/01616412.2018.1451266] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Feng Yan
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Zhang Yi
- Drug Clinical Trial Institution, Tianjin Huanhu Hospital, Tianjin, China
| | - Yang Hua
- Department of Ultrasound, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Ying Shen
- Department of Traditional Chinese Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Ming Li
- China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yuchuan Ding
- China-America Institute of Neuroscience, Xuanwu Hospital, Capital Medical University, Beijing, China
- Department of Neurosurgery, Wayne State University School of Medicine, Detroit, MI, USA
| | - Ankush Chandra
- Department of Neurosurgery, Wayne State University School of Medicine, Detroit, MI, USA
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Xunming Ji
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Wei Yue
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China
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Alhazzani AA, Mahfouz AA, Abolyazid AY, Awadalla NJ, Aftab R, Faraheen A, Khalil SN. Study of Stroke Incidence in the Aseer Region, Southwestern Saudi Arabia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E215. [PMID: 29373563 PMCID: PMC5858284 DOI: 10.3390/ijerph15020215] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Revised: 01/12/2018] [Accepted: 01/22/2018] [Indexed: 11/16/2022]
Abstract
Recent data regarding first-stroke incidence in Saudi Arabia in general and in the Aseer region in particular are scarce and even lacking. The aim of this work was to study the first-time stroke incidence in the Aseer region, southwestern Saudi Arabia. All first-stroke patients admitted to all hospitals in the Aseer region over a one-year period (January through December 2016) were included. Stroke patients outside the Aseer region were excluded from the study. The incidence per 100,000 patients and the concomitant 95% CI (Confidence Intervals) were computed. The present study included 1249 first-time stroke patients and calculated an overall minimal incidence rate of hospitalized first-time stroke of 57.64 per 100,000 persons per year (95% CI: 57.57-57.70). A steady increase was noticed depending on the patients' age, reaching a figure of 851.81 (95% CI: 849.2-854.5) for those patients aged 70 years and more. Overall, the incidence rate for females (48.14; 95% CI: 48.04-48.24) was lower compared to males (65.52; 95% CI: 65.1-66.0). Taking into consideration the expected rise of the elderly because of the prominent medical services provided by the Saudi government, leading to a subsequent change in the horizontal and vertical age distribution structure of the population, an increase in the number of stroke patients is expected. It is suggested to establish a nationwide stroke surveillance system in the Kingdom, with the objective to report, analyze, and maintain an updated overview of the stroke status in Saudi Arabia.
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Affiliation(s)
- Adel A Alhazzani
- Department of Internal Medicine, College of Medicine, King Khalid University, P.O. Box 641, Abha 61421, Saudi Arabia.
| | - Ahmed A Mahfouz
- Department of Family and Community Medicine, College of Medicine, King Khalid University, P.O. Box 641, Abha 61421, Saudi Arabia.
- Department of Epidemiology, High Institute of Public Health, Alexandria University, Alexandria 21511, Egypt.
| | - Ahmed Y Abolyazid
- Department of Family and Community Medicine, College of Medicine, King Khalid University, P.O. Box 641, Abha 61421, Saudi Arabia.
- Department of Community Medicine, College of Medicine, Mansoura University, Mansoura 35516, Egypt.
| | - Nabil J Awadalla
- Department of Family and Community Medicine, College of Medicine, King Khalid University, P.O. Box 641, Abha 61421, Saudi Arabia.
- Department of Community Medicine, College of Medicine, Mansoura University, Mansoura 35516, Egypt.
| | - Razia Aftab
- Department of Family and Community Medicine, College of Medicine, King Khalid University, P.O. Box 641, Abha 61421, Saudi Arabia.
| | - Aesha Faraheen
- Department of Family and Community Medicine, College of Medicine, King Khalid University, P.O. Box 641, Abha 61421, Saudi Arabia.
| | - Shamsun Nahar Khalil
- Department of Family and Community Medicine, College of Medicine, King Khalid University, P.O. Box 641, Abha 61421, Saudi Arabia.
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Abstract
Stroke is the second largest cause of disability-adjusted life-years lost worldwide. The prevalence of stroke in women is predicted to rise rapidly, owing to the increasing average age of the global female population. Vascular risk factors differ between women and men in terms of prevalence, and evidence increasingly supports the clinical importance of sex differences in stroke. The influence of some risk factors for stroke - including diabetes mellitus and atrial fibrillation - are stronger in women, and hypertensive disorders of pregnancy also affect the risk of stroke decades after pregnancy. However, in an era of evidence-based medicine, women are notably under-represented in clinical trials - despite governmental actions highlighting the need to include both men and women in clinical trials - resulting in a reduced generalizability of study results to women. The aim of this Review is to highlight new insights into specificities of stroke in women, to plan future research priorities, and to influence public health policies to decrease the worldwide burden of stroke in women.
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Sex Differences in the Clinical Features, Risk Factors, and Outcomes of Intracerebral Hemorrhage: a Large Hospital-based Stroke Registry in China. Sci Rep 2017; 7:286. [PMID: 28325919 PMCID: PMC5428271 DOI: 10.1038/s41598-017-00383-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 02/21/2017] [Indexed: 11/09/2022] Open
Abstract
Intracerebral hemorrhage (ICH) is common in China. However, the sex differences in clinical features, risk factors, and outcomes of ICH remain controversial. Between 2005 and 2014, we recruited patients with primary ICH in Tianjin, China, and evaluated sex differences in clinical features, risk factors, and outcomes at 3, 12, and 36 months after ICH. The 1,325 patients included 897 men (67.7%) and 428 women (32.3%). The mean age at ICH onset was younger among men (59.14 years) than among women (63.12 years, P < 0.001). Men were more likely to have a hematoma in the basal ganglia, while women were more likely to have one in the thalamus. Women had higher frequencies of urinary tract infections, diabetes mellitus, cardiovascular diseases, and obesity. Men had a greater risk of death at 3 months after ICH. However, no sex differences were observed for mortality at 12 and 36 months after ICH or for recurrence and dependency at 3, 12, and 36 months after ICH. These findings suggested that it crucial to strengthen management of AF and complications in patients with ICH, especially management of blood pressure in men for reducing the mortality rates and the burden of ICH in China.
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Hsieh JT, Ang BT, Ng YP, Allen JC, King NKK. Comparison of Gender Differences in Intracerebral Hemorrhage in a Multi-Ethnic Asian Population. PLoS One 2016; 11:e0152945. [PMID: 27050549 PMCID: PMC4822850 DOI: 10.1371/journal.pone.0152945] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 03/20/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Intracerebral hemorrhage (ICH) accounts for 10-15% of all first time strokes and with incidence twice as high in the Asian compared to Western population. This study aims to investigate gender differences in ICH patient outcomes in a multi-ethnic Asian population. METHOD Data for 1,192 patients admitted for ICH were collected over a four-year period. Multivariate logistic regression was used to identify independent predictors and odds ratios were computed for 30-day mortality and Glasgow Outcome Scale (GOS) comparing males and females. RESULT Males suffered ICH at a younger age than females (62.2 ± 13.2 years vs. 66.3 ± 15.3 years; P<0.001). The occurrence of ICH was higher among males than females at all ages until 80 years old, beyond which the trend was reversed. Females exhibited increased severity on admission as measured by Glasgow Coma Scale compared to males (10.9 ± 4.03 vs. 11.4 ± 4.04; P = 0.030). No difference was found in 30-day mortality between females and males (F: 30.5% [155/508] vs. M: 27.0% [186/688]), with unadjusted and adjusted odds ratio (F/M) of 1.19 (P = 0.188) and 1.21 (P = 0.300). At discharge, there was a non-statistically significant but potentially clinically relevant morbidity difference between the genders as measured by GOS (dichotomized GOS of 4-5: F: 23.7% [119/503] vs. M: 28.7% [194/677]), with unadjusted and adjusted odds ratio (F/M) of 0.77 (P = 0.055) and 0.87 (P = 0.434). CONCLUSION In our multi-ethnic Asian population, males developed ICH at a younger age and were more susceptible to ICH than women at all ages other than the beyond 80-year old age group. In contrast to the Western population, neurological status of female ICH patients at admission was poorer and their 30-day mortality was not reduced. Although the study was not powered to detect significance, female showed a trend toward worse 30-day morbidity at discharge.
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Affiliation(s)
- Justin T. Hsieh
- School of Medicine, Duke-National University of Singapore Medical School, Singapore, Singapore
- * E-mail:
| | - Beng Ti Ang
- Department of Neurosurgery, National Neuroscience Institute, Singapore, Singapore
| | - Yew Poh Ng
- Department of Neurosurgery, National Neuroscience Institute, Singapore, Singapore
| | - John C. Allen
- Center for Quantitative Medicine, Duke-National University of Singapore Medical School, Singapore, Singapore
| | - Nicolas K. K. King
- Department of Neurosurgery, National Neuroscience Institute, Singapore, Singapore
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10
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Shigematsu K, Watanabe Y, Nakano H. Lower hazard ratio for death in women with cerebral hemorrhage. Acta Neurol Scand 2015; 132:59-64. [PMID: 25643895 DOI: 10.1111/ane.12359] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The aim of the study was to clarify the hazard ratio for death within 30 days after stroke comparing women to men. MATERIAL AND METHODS We reviewed all stroke patients registered in the Kyoto Stroke Registry (from January 1999 to December 2009) in Japan. Hazard ratio (HR) for death and 95% confidence interval were calculated by the Cox regression in stroke and in each stroke subtype: cerebral infarction (CI), cerebral hemorrhage, (CH) and subarachnoid hemorrhage (SAH). We also evaluated HR for death in women in each consciousness level at the onset of stroke: the Japan Coma Scale (JCS) 0 (alert), JCS 1-digit code (disoriented but awake), JCS 2-digit code (arousable with stimulation), and JCS 3-digit code (unarousable). RESULTS A total of 13,788 patients were analyzed. HR for death comparing women to men were 1.04 (0.88-1.23, P = 0.66 in stroke as a whole), 0.91 (0.69-1.21, P = 0.51 in CI), 0.53 (0.41-0.71, P < 0.01 in CH), and 0.89 (0.60-1.30, P = 0.535 in SAH) after adjustment for age and histories of hypertension, arrhythmia, diabetes mellitus and hyperlipemia and uses of tobacco and alcohol. Stratified by JCS, HR for death in women with CH were 0.32 (0.11-0.94 in JCS0), 0.48 (0.28-0.82 in JCS1), 0.49 (0.28-0.83 in JCS2), and 0.79 (0.65-0.97 in JCS3), respectively. HR for death in women with CI in JCS3 was significantly lower than in men (0.71; 0.52-0.98). CONCLUSION We evaluated HR for death comparing men to women in stroke and in each stroke subtype. Women with CH had lower HR for death within 30 days after stroke than men.
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Affiliation(s)
- K. Shigematsu
- Department of Neurology; National Hospital Organization; Minami Kyoto Hospital; Kyoto Japan
| | - Y. Watanabe
- Department of Epidemiology for Community Health and Medicine; Graduate School of Medical Science; Kyoto Prefectural University of Medicine; Kyoto Japan
| | - H. Nakano
- Department of Neurosurgery; Kyoto Kidugawa Hospital; Kyoto Japan
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Olindo S, Chausson N, Mejdoubi M, Jeannin S, Rosillette K, Saint-Vil M, Signate A, Edimonana-Kaptue M, Larraillet V, Cabre P, Smadja D, Joux J. Trends in Incidence and Early Outcomes in a Black Afro-Caribbean Population From 1999 to 2012. Stroke 2014; 45:3367-73. [DOI: 10.1161/strokeaha.114.005930] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Stephane Olindo
- From the Department of Neurology (S.O., S.J., K.R., M.S.-V., A.S., M.E.-K., P.C., J.J.), Department of Neuroradiology (M.M.), and Department of Geriatrics (V.L.), University Hospital of Martinique, Fort de France, Martinique FWI; and Department of Neurology, Hospital Sud Francilien, Corbeil-Essonnes, France (N.C., D.S.)
| | - Nicolas Chausson
- From the Department of Neurology (S.O., S.J., K.R., M.S.-V., A.S., M.E.-K., P.C., J.J.), Department of Neuroradiology (M.M.), and Department of Geriatrics (V.L.), University Hospital of Martinique, Fort de France, Martinique FWI; and Department of Neurology, Hospital Sud Francilien, Corbeil-Essonnes, France (N.C., D.S.)
| | - Mehdi Mejdoubi
- From the Department of Neurology (S.O., S.J., K.R., M.S.-V., A.S., M.E.-K., P.C., J.J.), Department of Neuroradiology (M.M.), and Department of Geriatrics (V.L.), University Hospital of Martinique, Fort de France, Martinique FWI; and Department of Neurology, Hospital Sud Francilien, Corbeil-Essonnes, France (N.C., D.S.)
| | - Severine Jeannin
- From the Department of Neurology (S.O., S.J., K.R., M.S.-V., A.S., M.E.-K., P.C., J.J.), Department of Neuroradiology (M.M.), and Department of Geriatrics (V.L.), University Hospital of Martinique, Fort de France, Martinique FWI; and Department of Neurology, Hospital Sud Francilien, Corbeil-Essonnes, France (N.C., D.S.)
| | - Karine Rosillette
- From the Department of Neurology (S.O., S.J., K.R., M.S.-V., A.S., M.E.-K., P.C., J.J.), Department of Neuroradiology (M.M.), and Department of Geriatrics (V.L.), University Hospital of Martinique, Fort de France, Martinique FWI; and Department of Neurology, Hospital Sud Francilien, Corbeil-Essonnes, France (N.C., D.S.)
| | - Martine Saint-Vil
- From the Department of Neurology (S.O., S.J., K.R., M.S.-V., A.S., M.E.-K., P.C., J.J.), Department of Neuroradiology (M.M.), and Department of Geriatrics (V.L.), University Hospital of Martinique, Fort de France, Martinique FWI; and Department of Neurology, Hospital Sud Francilien, Corbeil-Essonnes, France (N.C., D.S.)
| | - Aissatou Signate
- From the Department of Neurology (S.O., S.J., K.R., M.S.-V., A.S., M.E.-K., P.C., J.J.), Department of Neuroradiology (M.M.), and Department of Geriatrics (V.L.), University Hospital of Martinique, Fort de France, Martinique FWI; and Department of Neurology, Hospital Sud Francilien, Corbeil-Essonnes, France (N.C., D.S.)
| | - Mireille Edimonana-Kaptue
- From the Department of Neurology (S.O., S.J., K.R., M.S.-V., A.S., M.E.-K., P.C., J.J.), Department of Neuroradiology (M.M.), and Department of Geriatrics (V.L.), University Hospital of Martinique, Fort de France, Martinique FWI; and Department of Neurology, Hospital Sud Francilien, Corbeil-Essonnes, France (N.C., D.S.)
| | - Veronique Larraillet
- From the Department of Neurology (S.O., S.J., K.R., M.S.-V., A.S., M.E.-K., P.C., J.J.), Department of Neuroradiology (M.M.), and Department of Geriatrics (V.L.), University Hospital of Martinique, Fort de France, Martinique FWI; and Department of Neurology, Hospital Sud Francilien, Corbeil-Essonnes, France (N.C., D.S.)
| | - Philippe Cabre
- From the Department of Neurology (S.O., S.J., K.R., M.S.-V., A.S., M.E.-K., P.C., J.J.), Department of Neuroradiology (M.M.), and Department of Geriatrics (V.L.), University Hospital of Martinique, Fort de France, Martinique FWI; and Department of Neurology, Hospital Sud Francilien, Corbeil-Essonnes, France (N.C., D.S.)
| | - Didier Smadja
- From the Department of Neurology (S.O., S.J., K.R., M.S.-V., A.S., M.E.-K., P.C., J.J.), Department of Neuroradiology (M.M.), and Department of Geriatrics (V.L.), University Hospital of Martinique, Fort de France, Martinique FWI; and Department of Neurology, Hospital Sud Francilien, Corbeil-Essonnes, France (N.C., D.S.)
| | - Julien Joux
- From the Department of Neurology (S.O., S.J., K.R., M.S.-V., A.S., M.E.-K., P.C., J.J.), Department of Neuroradiology (M.M.), and Department of Geriatrics (V.L.), University Hospital of Martinique, Fort de France, Martinique FWI; and Department of Neurology, Hospital Sud Francilien, Corbeil-Essonnes, France (N.C., D.S.)
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Zhou J, Zhang Y, Arima H, Zhao Y, Zhao H, Zheng D, Tian Y, Liu Y, Huang Q, Yang J. Sex differences in clinical characteristics and outcomes after intracerebral haemorrhage: results from a 12-month prospective stroke registry in Nanjing, China. BMC Neurol 2014; 14:172. [PMID: 25182069 PMCID: PMC4159550 DOI: 10.1186/s12883-014-0172-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2014] [Accepted: 08/28/2014] [Indexed: 12/05/2022] Open
Abstract
Background There is uncertainty surrounding the differences in outcomes after intracerebral haemorrhage (ICH) between men and women. This study aimed to investigate the sex differences in clinical characteristics, severity and outcomes of Chinese ICH patients. Methods The Nanjing First Hospital stroke registry was a hospital-based registry of stroke patients with 1-year prospective follow-up. From 2004 to 2008, a total of 651 consecutively recruited patients with acute ICH were enrolled. Primary outcome was death or dependency defined as a modified Rankin Scale score of 3–6 at 12 months. Multivariable logistic regression analyses were performed to determine whether there were sex differences in clinical outcomes after ICH. Clinically important and biologically plausible risk factors of death or dependency were selected from available variables. Results A total of 615 ICH patients were enrolled. There was no significant difference in age (63.5 ± 14.0 vs. 62.7 ± 12.7, p = 0.500) between women and men. At baseline, men were more likely to be current smokers (46.1% vs. 3.6%, P < 0.001) or current drinkers (35.4% vs. 3.6%, P < 0.001), but women had higher admission National Institute of Health Stroke Scale (NIHSS) scores than men (10 vs. 8, P = 0.039). Women also had higher rates of death or dependency at 3, 6, and 12 months (61.2% vs. 46.8%, P = 0.001; 56.7% vs. 45.3%, P = 0.009; and 51.8% vs. 44.1%, P = 0.065; respectively). After adjustment for age, existing hypertension and diabetes, prior stroke, previous ischemic heart disease, previous atrial fibrillation, current smoking and alcohol consumption status, pre-stroke dependency, onset-to-door time, admission NIHSS score, admission systolic blood pressure and location of bleeding, the association between the female gender and death or dependency remained statistical significant at 3 months [odds ratio (OR): 1.76; 95% confidence interval (CI): 1.07-2.89], but did not reach statistical significance at 6 months (OR: 1.59; 95% CI: 0.99-2.54) and 12 months (OR: 1.22; 95% CI: 0.77-1.95). Conclusions In a Chinese population, women are more likely to be dead or dependent early after ICH than men. However, this gender difference gradually attenuates over the period of 12 months.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Jie Yang
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, 68 Changle Road, Nanjing 210006, Jiangsu, China.
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Edgell H, Robertson AD, Hughson RL. Hemodynamics and brain blood flow during posture change in younger women and postmenopausal women compared with age-matched men. J Appl Physiol (1985) 2012; 112:1482-93. [DOI: 10.1152/japplphysiol.01204.2011] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Increased incidence of orthostatic hypotension and presyncopal symptoms in young women could be related to hormonal factors that might be isolated by comparing cardiovascular and cerebrovascular responses to postural change in young and older men and women. Seven young women, 11 young men, 10 older women (>1 yr postmenopausal, no hormone therapy), and 9 older men participated in a supine-to-sit-to-stand test while measuring systemic hemodynamics, end-tidal Pco2, and blood flow velocity of the middle cerebral artery (MCA). Women had a greater reduction in stroke volume index compared with age-matched men (change from supine to standing: young women: −22.9 ± 1.6 ml/m2; young men: −14.4 ± 2.4 ml/m2; older women: −17.4 ± 3.3 ml/m2; older men: −13.8 ± 2.2 ml/m2). This was accompanied by offsetting changes in heart rate, particularly in young women, resulting in no age or sex differences in cardiac output index. Mean arterial pressure (MAP) was higher in older subjects and increased with movement to upright postures. Younger men and women had higher forearm vascular resistance that increased progressively in the upright posture compared with older men and women. There was no difference between sexes or ages in total peripheral resistance index. Women had higher MCA velocity, but both sexes had reduced MCA velocity while upright, which was a function of reduced blood pressure at the MCA and a significant reduction in end-tidal Pco2. The reductions in stroke volume index suggested impaired venous return in women, but augmented responses of heart rate and forearm vascular resistance protected MAP in younger women. Overall, these results showed significant sex and age-related differences, but compensatory mechanisms preserved MAP and MCA velocity in young women.
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Affiliation(s)
- H. Edgell
- Faculty of Applied Health Sciences, University of Waterloo, Waterloo, Ontario; and
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - A. D. Robertson
- Faculty of Applied Health Sciences, University of Waterloo, Waterloo, Ontario; and
| | - R. L. Hughson
- Faculty of Applied Health Sciences, University of Waterloo, Waterloo, Ontario; and
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