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Sex differences in risk factors for aneurysmal subarachnoid haemorrhage: systematic review and meta-analysis


Rehman, S and Sahle, BW and Chandra, RV and Dwyer, M and Thrift, AG and Callisaya, M and Breslin, M and Phan, HT and Otahal, P and Gall, S, Sex differences in risk factors for aneurysmal subarachnoid haemorrhage: systematic review and meta-analysis, Journal of the Neurological Sciences, 406 Article 116446. ISSN 0022-510X (2019) [Refereed Article]

Copyright Statement

Copyright 2019 Elsevier B.V.

DOI: doi:10.1016/j.jns.2019.116446


Background: Aneurysmal subarachnoid haemorrhage (aSAH) disproportionally affects women. We conducted a systematic review and meta-analysis to explore sex differences in aSAH risk factors.

Methods: Case-control/cohort studies were searched to November 2017 with sex-specific risk factors for aSAH. Meta-analysis was performed when a risk factor was reported in ≥2 studies.

Results: Of 31 studies, 22 were eligible for meta-analysis. Female sex was associated with greater odds of aSAH (HRadjusted 1.90 [1.47-2.46]. There was no detectable difference between the sexes for hypertension (ORadjusted: men 3.13 [2.26-4.34]; women 3.65 [2.87-4.63], p = .18), smoking (ORadjusted: men 2.96 [1.68-5.21]; women 3.11 [1.21-7.97], p = .95), aSAH family history, systolic blood pressure, age and some genetic variations. Alcohol (ORadjusted: men 1.50 [1.04-2.17]; women 0.83 [0.48-1.45], p = .003), high alanine aminotransferase levels, and some gene variants increased the risk of aSAH in men. Reproductive factors, divorce and some genetic variations increased the risk in women. High aspartate aminotransferase levels in men and, diabetes (ORadjusted: men 0.57 [0.32-1.01]; women 0.24 [0.13-0.43], p = .01) and parity in women reduced aSAH risk.

Conclusion: We recommend sex-specific re-analysis of existing studies of aSAH risk factors. Known aSAH risk factors (hypertension, smoking and alcohol consumption) should be targeted to prevent aSAH in men and women.

Item Details

Item Type:Refereed Article
Keywords:risk factors, sex characteristics, subarachnoid haemorrhage
Research Division:Biomedical and Clinical Sciences
Research Group:Neurosciences
Research Field:Neurology and neuromuscular diseases
Objective Division:Health
Objective Group:Evaluation of health and support services
Objective Field:Evaluation of health outcomes
UTAS Author:Rehman, S (Dr Sabah Rehman)
UTAS Author:Sahle, BW (Mr Berhe Sahle)
UTAS Author:Dwyer, M (Dr Mitchell Dwyer)
UTAS Author:Callisaya, M (Dr Michele Callisaya)
UTAS Author:Breslin, M (Dr Monique Breslin)
UTAS Author:Phan, HT (Dr Hoang Phan)
UTAS Author:Otahal, P (Mr Petr Otahal)
UTAS Author:Gall, S (Associate Professor Seana Gall)
ID Code:135226
Year Published:2019
Web of Science® Times Cited:8
Deposited By:Menzies Institute for Medical Research
Deposited On:2019-10-08
Last Modified:2019-11-11

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