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Sex differences in incidence, mortality, and survival in individuals with stroke in Scotland, 1986 to 2005


Lewsey, JD and Gillies, M and Jhund, PS and Chalmers, JWT and Redpath, A and Briggs, A and Walters, M and Langhorne, P and Capewell, S and McMurray, JJV and Macintyre, K, Sex differences in incidence, mortality, and survival in individuals with stroke in Scotland, 1986 to 2005, Stroke: A Journal of Cerebral Circulation, 40, (4) pp. 1038-1043. ISSN 0039-2499 (2009) [Refereed Article]

DOI: doi:10.1161/STROKEAHA.108.542787


BACKGROUND AND PURPOSE: The aim of this study was to examine the effect of sex across different age groups and over time for stroke incidence, 30-day case-fatality, and mortality.

METHODS: All first hospitalizations for stroke in Scotland (1986 to 2005) were identified using linked morbidity and mortality data. Age-specific rate ratios (RRs) for comparing women with men for both incidence and mortality were modeled with adjustment for study year and socioeconomic deprivation. Logistic regression was used to model 30-day case-fatality.

RESULTS: Women had a lower incidence of first hospitalization than men and size of effect varied with age (55 to 64 years, RR=0.65, 95% CI 0.63 to 0.66; >or=85 years, RR=0.94, 95% CI 0.91 to 0.96). Women aged 55 to 84 years had lower mortality than men and again size of effect varied with age (65 to 74 years, RR=0.79, 95% CI 0.76 to 0.81); 75 to 84 years, RR=0.94, 95% CI 0.92 to 0.95). Conversely, women aged >or=85 years had 15% higher stroke mortality than men (RR=1.15, 95% CI 1.12 to 1.18). Adjusted risk of death within 30 days was significantly higher in women than men, and this difference increased over the 20-year period in all age groups (adjusted OR in 55 to 64 year olds 1.23, 95% CI 1.14 to 1.33 in 1986 and 1.51, 95% CI 1.39 to 1.63 in 2005).

CONCLUSIONS: We observed lower rates of incidence and mortality in younger women than men. However, higher numbers of older women in the population mean that the absolute burden of stroke is greater in women. Short-term case-fatality is greater in women of all ages and, worryingly, these differences have increased from 1986 to 2005.

Item Details

Item Type:Refereed Article
Keywords:Cerebrovascular disease; Epidemiology; Prognosis; Sex
Research Division:Biomedical and Clinical Sciences
Research Group:Cardiovascular medicine and haematology
Research Field:Cardiology (incl. cardiovascular diseases)
Objective Division:Health
Objective Group:Clinical health
Objective Field:Clinical health not elsewhere classified
UTAS Author:Macintyre, K (Dr Kate Macintyre)
ID Code:95698
Year Published:2009
Web of Science® Times Cited:58
Deposited By:Medicine
Deposited On:2014-10-07
Last Modified:2014-10-07

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