Abstract 60: Diverging Time Trends Of Gender-specific Ischemic Stroke Incidence - 10-year-analysis Of A State-wide Registry In Germany

Abstract

Introduction: The incidence of ischemic stroke (IS) was previously expected to rise among countries with an ageing population. Lately, several studies from developed countries have reported a decline in certain cohorts. Whether this applies to all genders, however, is uncertain along with limited data on the temporal development in incidence, treatment, and recovery. Methods: We analyzed a prospective stroke inpatient quality assurance registry of the federal state of Hesse, Germany. Recruitment of all patients with a final diagnosis of ischemic stroke at hospital discharge (ICD10: I63) is mandatory by law. Stroke incidence rates were calculated based on census data of all inhabitants and stratified according to age. Results: Between 2010 and 2019 141,277 patients were included, 73,770 (52.2%) male and 67.507 (47.8%) female. Overall, the incidence of IS was 228/100,000 in 2010 and 226/100,000 in 2019 (OR 0.99; 95%-CI 0.96 to 1.02; p=0.50). For men, the incidence increased continuously from 236/100,000 to 245/100,000, in women it decreased from 220/100,000 to 208/100,000. After adjusting for age, the odds ratio for IS between men and women was 1.40 in 2010 (95%-CI 1.35 to 1.44; p<0.01) and 1.48 in 2019 (95%-CI 1.43 to 1.53; p<0.01). This trend was most pronounced in men aged 45 to 59 years with an increase from 151/100,000 to 176/100,000. In this age group, men had higher rates of prior strokes (16.3% vs. 14.3%; p<0.01), arterial hypertension (67.3% vs. 61.2%; p<0.01) and diabetes (20.6% vs. 17.9%; p<0.01) than women. Atrial fibrillation was more common in women (30.8% vs. 22.6%; p<0.01). The modified Rankin Scale (mRS) on hospital discharge has generally improved from 2010 to 2019 (median 2 vs. 2; Mann-Whitney-U-test p<0.01) with a more favorable outcome in men (mRS 0-2: OR 1.29; 95%-CI 1.26 to 1.32; p<0.01). Discussion: Over the last decade, the overall incidence of IS has declined predominantly in the female population. Contrarily, for men the incidence has risen by about 4% with a steeper increase of 17% in males aged 45-59 years. This finding could be explained by higher rates of prior strokes, arterial hypertension and diabetes in men compared to women. Notably, the high rate of recurrent strokes in men provides a cautionary tale for effective secondary prevention.