Abstract 3357: Women Have Higher Odds of Dying within 3 Months of a Stroke than Men

Abstract

Background: In recent years, the public health burden of stroke in women has become apparent. Due to their greater longevity, more women than men have strokes each year. Numerous studies have shown that women fare worse than men with regards to in-hospital treatment, vascular risk factor control, and disability after stroke; however, data regarding sex differences in stroke mortality are conflicting. Objective: To conduct a systematic review and meta-analysis investigating the relation of sex with short-term and long-term mortality after stroke. Methods: We performed a systematic search of Pubmed, Cochrane Library, MEDLINE, LILACS, review articles, and reference lists with the terms “ischemic stroke” or “cerebral ischemia” or “brain ischemia” crossed with “sex differences” or “gender differences” or “sex-specific” crossed with “case fatality” or “mortality” or “in-hospital mortality” or “outcome” or “survival” or “death.” We restricted our search to humans. There were no language restrictions. Entry criteria were as follows: (1) sex-specific rates of 1 of the following assessed: in-hospital, 1-month, or 90-day mortality; (2) ischemic stroke, and (3) adults (>18 years). All data from eligible studies were abstracted by 3 independent investigators according to a standard protocol. Discrepancies were resolved by discussion with a 4 th investigator and by referencing the original report. Heterogeneity was assessed by the probability value of chi square statistics and I 2 . The primary endpoint was short-term mortality (at 0-3 months) and the secondary endpoint was long-term mortality (at 12-18 months). Results: The literature review yielded 21 studies which met entry criteria. Of these, 6 provided female to male odds ratios of short-term mortality (n=3,183,110) and 3 provided female to male odds ratios of long-term mortality (n=104,141). Overall, women had higher short-term (OR 1.11, 95% CI 1.03-1.19)( Figure1 ) and long-term (OR 1.12, 95% CI 0.97-1.28)( Figure 2 ) mortality compared to men, although the latter was not significant. Conclusion: Women are more likely than men to die within the first 3 months of an index stroke. Intensified efforts at mitigating post-stroke complications and improving vascular risk factor control among female stroke survivors may aid in reducing this disparity. Figure 1 Figure 2