Différences sexuelles dans la mortalité par accident vasculaire cérébral en Thaïlande : une étude de cohorte nationale

Abstract

BackgroundOver half of the growing global stroke-mortality burden is accounted for by the East-Asian-subcontinent alone. Sex differences in stroke-mortality in the Asian population is yet to be assessed in the literature. We aimed to assess the sex-differences in mortality following stroke in a large cohort of Thai-patients. MethodAll stroke admissions between 2004–2015 were included from the Thailand public-health-insurance-database. The association between sex and mortality was assessed in-hospital, at 1 month, 1 year and 5 years, using multivariable Cox-regressions, separately for ischaemic-stroke (IS), haemorrhagic-stroke (HS) and stroke-of-undetermined-type(SUT), adjusting for confounders. Results608,890 patients were included: 370,527 patients with IS(60.9%), 173,236 with HS(28.5%) and 65,127 with SUT(10.6%). Women were older than men in all three groups and had higher prevalence of comorbidities. Adjusted hazard-ratios(HRs) of mortality showed women had higher mortality post-IS compared to men (in-hospital: HR: 1.20; 95% CI: 1.17–1.23; 1 month: HR: 1.17; 95% CI: 1.15–1.20; 1 year: HR: 1.10; 95% CI: 1.09–1.12 and 5 years: HR: 1.02; 95% CI: 1.01–1.03). Women also had higher mortality after HS (in-hospital: HR: 1.02; 95% CI: 1.00–1.04; 1 month: HR: 1.08; 95% CI: 1.06–1.10; 1 year: HR: 1.04; 95% CI: 1.03–1.06 and 5 years: HR: 1.09; 95% CI: 1.08–1.11), and SUT (in-hospital: HR: 1.04; 95% CI: 1.03–1.06; 1 month: HR: 1.20; 95% CI: 1.14–1.27; 1 year: HR: 1.14; 95% CI: 1.09–1.18 and 5 years: HR: 1.06; 95% CI: 1.03–1.10). ConclusionsCompared to men, women were older at time of stroke-diagnosis and had higher burden of stroke risk-factors. Women also had higher mortality after stroke regardless of stroke-type or duration since stroke-onset. Post-IS, excess stroke-mortality in women was greatest during the in-hospital period, whereas excess stroke-mortality increased with time in women who had HS. No clear relationship was found between duration since stroke-onset and mortality in patients who had SUT.