eCite Digital Repository

Sex Differences in Long-Term Mortality After Stroke in the INSTRUCT (INternational STRoke oUtComes sTudy): A Meta-Analysis of Individual Participant Data

Citation

Phan, HTK and Blizzard, CL and Reeves, MJ and Thrift, AG and Cadilhac, D and Sturm, J and Heeley, E and Otahal, P and Konstantinos, V and Anderson, C and Parmar, P and Krishnamurthi, R and Barker-Collo, S and Feigin, V and Bejot, Y and Cabral, NL and Carolei, A and Sacco, S and Chausson, N and Olindo, S and Rothwell, P and Silva, C and Correia, M and Magalhaes, R and Appelros, P and Korv, J and Vibo, R and Minelli, C and Gall, S, Sex Differences in Long-Term Mortality After Stroke in the INSTRUCT (INternational STRoke oUtComes sTudy): A Meta-Analysis of Individual Participant Data, Circulation: Cardiovascular Quality and Outcomes, 10, (2) Article e003436. ISSN 1941-7705 (2017) [Refereed Article]

Copyright Statement

2017 American Heart Association, Inc

DOI: doi:10.1161/CIRCOUTCOMES.116.003436

Abstract

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 mostly because of age but also stroke severity, atrial fibrillation, and prestroke functional limitations. Lower survival after stroke among the elderly is inevitable, but there may be opportunities for intervention, including better access to evidence-based care for cardiovascular and general health.

Item Details

Item Type:Refereed Article
Keywords:incidence, mortality, risk factors, stroke, women
Research Division:Medical and Health Sciences
Research Group:Public Health and Health Services
Research Field:Epidemiology
Objective Division:Health
Objective Group:Clinical Health (Organs, Diseases and Abnormal Conditions)
Objective Field:Cardiovascular System and Diseases
Author:Phan, HTK (Ms Hoang Phan)
Author:Blizzard, CL (Associate Professor Leigh Blizzard)
Author:Otahal, P (Mr Petr Otahal)
Author:Gall, S (Dr Seana Gall)
ID Code:115423
Year Published:2017
Web of Science® Times Cited:3
Deposited By:Menzies Institute for Medical Research
Deposited On:2017-03-23
Last Modified:2017-04-04
Downloads:0

Repository Staff Only: item control page