Sex Differences in Long-Term Mortality After Stroke in the INSTRUCT (INternational STRoke oUtComes sTudy)

作者：Hoang Thi Phan, Christopher Leigh Blizzard, Mathew J. Reeves, Amanda Gay Thrift, Dominique Ann-Michele Cadilhac, Jonathan William Sturm, Emma L. Heeley, Petr Otáhal, Vemmos Konstantinos, Craig S. Anderson, Priya G Kumari Parmar, Rita Krishnamurthi, Suzanne Lyn Barker-Collo, Valery L. Feigin, Yannick Béjot, Norberto Luiz Cabral, Antonio Carolei, Simona Sacco, Nicolas Chausson, Stéphane Olindo, Peter Malcolm Rothwell, Carolina Assunção Lucas da Silva, Manuel A. Correia, Rui Magalhães, Peter Appelros, Janika Kõrv, Riina Vibo, César Minelli, Seana Gall · 发表于：Circulation Cardiovascular Quality and Outcomes · 年份：2017 · DOI：10.1161/circoutcomes.116.003436 · 被引用次数：210 · 研究领域：Acute Ischemic Stroke Management、Stroke Rehabilitation and Recovery、Intracerebral and Subarachnoid Hemorrhage Research

BACKGROUND: Women are reported to have greater mortality after stroke than men, but the reasons are uncertain. We examined sex differences in mortality at 1 and 5 years after stroke and identified factors contributing to these differences. METHODS AND RESULTS: Individual participant data for incident strokes were obtained from 13 population-based incidence studies conducted in Europe, Australasia, South America, and the Caribbean between 1987 and 2013. Data on sociodemographics, stroke-related factors, prestroke health, and 1- and 5-year survival were obtained. Poisson modeling was used to estimate the mortality rate ratio (MRR) for women compared with men at 1 year (13 studies) and 5 years (8 studies) after stroke. Study-specific adjusted MRRs were pooled to create a summary estimate using random-effects meta-analysis. Overall, 16 957 participants with first-ever stroke followed up at 1 year and 13 216 followed up to 5 years were included. Crude pooled mortality was greater for women than men at 1 year (MRR 1.35; 95% confidence interval, 1.24-1.47) and 5 years (MRR 1.24; 95% confidence interval, 1.12-1.38). However, these pooled sex differences were reversed after adjustment for confounding factors (1 year MRR, 0.81; 95% confidence interval, 0.72-0.92 and 5-year MRR, 0.76; 95% confidence interval, 0.65-0.89). Confounding factors included age, prestroke functional limitations, stroke severity, and history of atrial fibrillation. CONCLUSIONS: Greater mortality in women is most...