Stroke Mortality In Men Research Articles

Spatiotemporal Correlation Analysis of Hydraulic Fracturing and Stroke in the United States.

Hydraulic fracturing or fracking has led to a rapid growth of oil and gas production in the United States, but the impact of fracking on public health is an important but underresearched topic. We designed a methodology to study spatiotemporal correlations between the risk of fracking and stroke mortality. An annualized loss expectancy (ALE) model is applied to quantify the risk of fracking. The geographically and temporally weighted regression (GTWR) model is used to analyze spatiotemporal correlations of stroke mortality, fracking ALE, and nine other socioeconomic- and health-related factors. The analysis shows that fracking ALE is moderately correlated with stroke mortality at ages over 65 in most states of fracking, in addition to cardiovascular disease and drug overdose being positively correlated with stroke mortality. Furthermore, the correlations between fracking ALE and stroke mortality in men appear to be higher than in women near the Marcellus Shale, including Ohio, Pennsylvania, West Virginia, and Virginia, while stroke mortality among women is concentrated in the Great Plains, including Montana, Wyoming, New Mexico, and Oklahoma. Lastly, within two kilometers of the fracking mining activity, the level of benzene in the air was found to be significantly correlated with the fracking activity in Colorado.

Stroke-Related Mortality at Different Altitudes: A 17-Year Nationwide Population-Based Analysis From Ecuador.

Introduction: Worldwide, more than 5.7% of the population reside above 1,500 m of elevation. It has been hypothesized that acute short-term hypoxia exposure could increase the risk of developing a stroke. Studies assessing the effect of altitude on stroke have provided conflicting results, some analyses suggest that long-term chronic exposure could be associated with reduced mortality and lower stroke incidence rates.Methods: An ecological analysis of all stroke hospital admissions, mortality rates, and disability-adjusted life years in Ecuador was performed from 2001 to 2017. The cases and population at risk were categorized in low (<1,500 m), moderate (1,500–2,500 m), high (2,500–3,500 m), and very high altitude (3,500–5,500 m) according to the place of residence. The derived crude and direct standardized age-sex adjusted mortality and hospital admission rates were calculated.Results: A total of 38,201 deaths and 75,893 stroke-related hospital admissions were reported. High altitude populations (HAP) had lower stroke mortality in men [OR: 0.91 (0.88–0.95)] and women [OR: 0.83 (0.79–0.86)]. In addition, HAP had a significant lower risk of getting admitted to the hospital when compared with the low altitude group in men [OR: 0.55 (CI 95% 0.54–0.56)] and women [OR: 0.65 (CI 95% 0.64–0.66)].Conclusion: This is the first epidemiological study that aims to elucidate the association between stroke and altitude using four different elevation ranges. Our findings suggest that living at higher elevations offers a reduction or the risk of dying due to stroke as well as a reduction in the probability of being admitted to the hospital. Nevertheless, this protective factor has a stronger effect between 2,000 and 3,500 m.

Age-period-cohort analysis of stroke mortality attributable to high systolic blood pressure in China and Japan

Stroke is a principal cause of mortality in China and Japan. High systolic blood pressure (SBP) was considered a chief risk factor for stroke mortality. Herein, we evaluated temporal trends of high SBP-attributable stroke mortality in China and Japan between 1990 and 2017. Data on stroke mortality were retrieved from the Global Burden of Disease Study 2017 (GBD 2017). Using the age-period-cohort method, we computed overall net drifts, local drifts, longitudinal age curves, and cohort/period rate ratios (RRs) for high SBP-attributable stroke mortality. The age-standardized mortality rates (ASMRs) displayed decreasing trends for high SBP-attributable stroke mortality. The annual net drift values were − 1.4% and − 3.5% in Chinese men and women versus − 3.1% and − 4.9% in Japanese men and women. The local drift values in both countries were < 0 among all age groups but were lower in women than in men. The longitudinal age curves showed a greater high SBP-attributable stroke mortality in men than in women across all age groups. Similar decreasing patterns were shown in the period and cohort RRs in both sexes with women having a quicker decline than men. In China and Japan, the ASMRs, as well as the period and cohort RRs of high SBP-attributable stroke mortality, decreased between 1990 and 2017 in both sexes and across all age groups. Yet, the prevalence of high SBP remained worrisome in both countries. Thus, SBP control should be encouraged to prevent stroke mortality.

Countries with women inequalities have higher stroke mortality.

Background Stroke outcomes can differ by women's legal or socioeconomic status. Aim We investigated whether differences in women's rights or gender inequalities were associated with stroke mortality at the country-level. Methods We used age-standardized stroke mortality data from 2008 obtained from the World Health Organization. We compared female-to-male stroke mortality ratio and stroke mortality rates in women and men between countries according to 50 indices of women's rights from Women, Business and the Law 2016 and Gender Inequality Index from the Human Development Report by the United Nations Development Programme. We also compared stroke mortality rate and income at the country-level. Results In our study, 176 countries with data available on stroke mortality rate in 2008 and indices of women's rights were included. There were 46 (26.1%) countries where stroke mortality in women was higher than stroke mortality in men. Among them, 29 (63%) countries were located in Sub-Saharan African region. After adjusting by country income level, higher female-to-male stroke mortality ratio was associated with 14 indices of women's rights, including differences in getting a job or opening a bank account, existence of domestic violence legislation, and inequalities in ownership right to property. Moreover, there was a higher female-to-male stroke mortality ratio among countries with higher Gender Inequality Index (r = 0.397, p < 0.001). Gender Inequality Index was more likely to be associated with stroke mortality rate in women than that in men (p < 0.001). Conclusions Our study suggested that the gender inequality status is associated with women's stroke outcomes.

Relation of Serum ^|^alpha;- and ^|^gamma;-Tocopherol Levels to Cardiovascular Disease-Related Mortality Among Japanese Men and Women

BackgroundThere is limited evidence regarding the relationship between serum tocopherol levels and cardiovascular disease.MethodsWe conducted a nested case-control study as part of the Japan Collaborative Cohort Study for evaluation of cancer risk (JACC Study). Baseline serum samples were collected from 39 242 participants (age range, 40–79 years) between 1988 and 1990. During the 13-year follow-up, there were 530 stroke deaths (302 ischemic strokes and 210 hemorrhagic strokes) and 211 deaths from coronary heart disease. Controls were matched for sex, age, and area of residence.ResultsSerum α-tocopherol level was not associated with any type of cardiovascular death in men; however, in women, it was inversely associated with total stroke mortality and hemorrhagic stroke mortality. The multivariate odds ratio (95% CI) for the highest versus the lowest quintile of serum α-tocopherol levels among women was 0.35 (0.16–0.77; P for trend = 0.009) for total stroke and 0.26 (0.07–0.97; P for trend = 0.048) for hemorrhagic stroke. Serum γ-tocopherol was inversely associated with ischemic stroke mortality in men but positively associated with hemorrhagic stroke mortality in women. The respective multivariate odds ratios (95% CI) for the highest versus the lowest quintile and for a 1-standard deviation increment in γ-tocopherol level were 0.48 (0.22–1.06; P for trend = 0.07) and 0.77 (0.58–1.02), respectively, for ischemic stroke in men and 3.10 (0.95–10.12; P for trend = 0.052) and 1.49 (1.04–2.13) for hemorrhagic stroke in women.ConclusionsAmong women, hemorrhagic stroke mortality was inversely associated with serum α-tocopherol and positively associated with serum γ-tocopherol. These findings are due in part to the antioxidative and antithrombotic activities of these tocopherols.

Total fluid and specific beverage intake and mortality due to IHD and stroke in the Netherlands Cohort Study

Chronic mild dehydration has been associated with several diseases, including fatal IHD and stroke. It has been suggested that hydration through total fluid intake (or water) is inversely associated with IHD or stroke mortality. The objective of the present study was to evaluate the relationship between total fluid (and specific beverage) intake and IHD or stroke mortality in the Netherlands Cohort Study (NLCS). In 1986, 120,852 participants aged 55-69 years were enrolled into the NLCS. Mortality data were collected over a 10-year follow-up period. Analysis was done through a case-cohort approach, and it was based on the subjects without a history of heart disease, stroke or diabetes at baseline. A total of 1789 IHD mortality cases and 708 stroke mortality cases occurred during the follow-up. Higher total fluid consumption was not associated with either IHD mortality or stroke mortality in men or women. When analysing specific beverages, a positive association between coffee consumption (increment 270 ml/d) and IHD mortality was observed in men (hazard ratio (HR) 1.09, 95% CI 1.00, 1.18), while an inverse relationship was observed in women (HR: 0.88, 95% CI 0.78, 1.00). For tea consumption (increment of 253 ml/d), an inverse relationship with IHD mortality was observed in men (HR: 0.91, 95% CI 0.83, 1.00). No association with water intake was observed. In the study population, fresh water consumption was very low. In conclusion, total fluid intake was not associated with IHD or stroke mortality in either men or women. Coffee consumption was inversely associated with IHD mortality in women only, while a higher tea intake was associated with lower IHD mortality in men only.

Blood Pressure and the Risk of Stroke, Cardiovascular Disease, and All-Cause Mortality Among Japanese: The JPHC Study

Little is known about the influence of blood pressure (BP) on cardiovascular disease (CVD) outcomes among Asian populations. We examined population attributable fractions (PAFs) and hazard ratios (HRs) associated with BP in relation to stroke and coronary heart disease (CHD) incident and mortality within a cohort of 33,372 Japanese men and women aged 40-69 years, free of prior diagnosis of cancer and CVD. The BP was classified based on modified criteria of the 2003 European Society of Hypertension-European Society of Cardiology guidelines. A total of 943 stroke events, 182 CHD events, 262 stroke deaths, and 120 CHD deaths occurred between the baseline questionnaire (1990-1994) and the end of follow-up in 31 December 2003. BP levels were linearly associated with incidence and mortality of CVD in men and women. According to the PAF estimation, the elimination of normal to severe hypertension would prevent 64% of stroke incidence in men and 50% in women; 67% of stroke mortality in men and 29% in women; and 38% of total CVD mortality in men and 36% in women. The PAF estimate for total stroke incidence was the highest for mild hypertension, and lower for moderate to severe hypertension in both sexes. The contributions of normal BP, high normal BP, and mild hypertension to the occurrence of stroke events were greater than those made by moderate and severe hypertension, highlighting the importance of primary prevention and of treatment for low-to-moderate degrees of hypertension.

Hyperglycemia and Stroke Mortality

OBJECTIVE—We investigated stroke mortality in individuals in different categories of glycemia and compared hazard ratios (HRs) corresponding to a 1-SD increase in 2-h plasma glucose and fasting plasma glucose (FPG) criteria.RESEARCH DESIGN AND METHODS—We examined data from 2-h 75-g oral glucose tolerance tests taken from 13 European cohorts comprising 11,844 (55%) men and 9,862 (45%) women who were followed up for a median of 10.5 years. A multivariate adjusted Cox proportional hazards model was used to estimate HRs for stroke mortality.RESULTS—In men and women without a prior history of diabetes, multivariate adjusted HRs for stroke mortality corresponding to a 1-SD increase in FPG were 1.02 (95% CI 0.83–1.25) and 1.52 (1.22–1.88) and those in 2-h plasma glucose 1.21 (1.06–1.38) and 1.31 (1.06–1.61), respectively. Addition of 2-h plasma glucose to the model with FPG significantly improved prediction of stroke mortality in men (χ2 = 10.12; P = 0.001) but not in women (χ2 = 0.01; P = 0.94), whereas addition of FPG to 2-h plasma glucose improved stroke mortality in women (χ2 = 4.08; P = 0.04) but not in men (χ2 = 3.29; P = 0.07).CONCLUSIONS—Diabetes defined by either FPG or 2-h plasma glucose increases the risk of stroke mortality. In individuals without a history of diabetes, elevated 2-h postchallenge glucose is a better predictor than elevated fasting glucose in men, whereas the latter is better than the former in women.

Social Support and Stroke and Coronary Heart Disease

Studies conducted in Western countries have found a robust association between social support and cardiovascular outcomes (eg, prognosis after myocardial infarction and functional recovery after stroke). However, less is known about the influence of social support on the same outcomes among Asian populations. In this prospective cohort study, we sought to examine the impact of social support on the incidence and mortality of coronary heart disease and stroke among the Japanese. We examined prospectively the association between social support and risk of coronary heart disease and stroke incidence and mortality within a cohort of 44,152 Japanese men and women aged 40 to 69 years, free of previous diagnosis of cancer and cardiovascular disease. A total of 301 cases of newly diagnosed coronary heart disease, 1057 strokes, 191 coronary heart disease deaths, and 327 stroke deaths occurred between the baseline questionnaire (1993-1994) and the end of follow-up in January 2004. The multivariate hazard ratios and 95% CI for stroke mortality in the highest social support versus lowest social support group was 1.45 (1.00 to 2.10) overall, 1.59 (1.01 to 2.51) for men, and 1.25 (0.63 to 2.46) for women. Social support was not associated with stroke incidence or coronary heart disease incidence and mortality. Low social support was associated with higher risk of stroke mortality in men. However, social support was not associated with stroke incidence, suggesting social support may be more important in stroke prognosis than preventing incidence.

Low Bone Mineral Density, Coronary Heart Disease, and Stroke Mortality in Men and Women: The Third National Health and Nutrition Examination Survey

The aim of this study is to determine the long-term association of bone mineral density and cardiovascular disease mortality. The data used are from the Third National Health and Nutrition Examination Survey (NHANES III), a nationally representative sample of noninstitutionalized civilians. A cohort of white, black, and Mexican-American persons ages 50 years and older at baseline (1988-1994) was followed through 2000 for coronary heart disease (CHD; n = 4690) and stroke mortality (n = 5272) using the NHANES III Linked Mortality File. Death certificates were used to identify 369 CHD and 166 stroke deaths. Results were evaluated to determine the relative risk of CHD or stroke per one standard deviation lower bone mineral density after adjusting for multiple risk factors. In Cox proportional hazards models, risk of CHD death and risk of stroke death were not associated with low bone mineral density among men. For women, no significant associations were found for stroke (relative risk, 1.34; 95% confidence interval, 0.86-2.07, p = 0.20) or CHD (relative risk, 1.26; 95% confidence interval, 0.88, 1.80; p = 0.21). Low bone mineral density was not associated with risk of cardiovascular disease in men. Among women with low bone mineral density, risk of CHD and stroke were elevated, but no significant associations were found.

Cardiorespiratory fitness and stroke mortality in men

LEE, C. D., and S. N. BLAIR. Cardiorespiratory fitness and stroke mortality in men. Med. Sci. Sports Exerc., Vol. 34, No. 4, pp. 592–595, 2002. Purpose We examined the association between cardiorespiratory fitness and stroke mortality in men. Methods This is a prospective cohort study. We followed 16,878 men, ages 40–87 yr, who had a complete medical evaluation including a maximal treadmill exercise test and self-reported health habits. There were 32 stroke deaths during an average of 10 yr of follow-up (167,961 man-yr). Results After adjustment for age and examination year, there was an inverse association between cardiorespiratory fitness and stroke mortality (P = 0.005 for trend). This association remained after further adjustment for cigarette smoking, alcohol intake, body mass index, hypertension, diabetes mellitus, and parental history of coronary heart disease (P = 0.02 for trend). High-fit men (most fit 40%) had 68% (95% CI: 0.12, 0.82) and moderate-fit men had 63% (95% CI: 0.17, 0.83) lower risk of stroke mortality when compared with low-fit men (least fit 20%), respectively. Conclusions Moderate and high levels of cardiorespiratory fitness were associated with lower risk of stroke mortality in men in the Aerobics Center Longitudinal study population.

Cardiorespiratory fitness and stroke mortality in men.

We examined the association between cardiorespiratory fitness and stroke mortality in men. This is a prospective cohort study. We followed 16,878 men, ages 40-87 yr, who had a complete medical evaluation including a maximal treadmill exercise test and self-reported health habits. There were 32 stroke deaths during an average of 10 yr of follow-up (167,961 man-yr). After adjustment for age and examination year, there was an inverse association between cardiorespiratory fitness and stroke mortality (P = 0.005 for trend). This association remained after further adjustment for cigarette smoking, alcohol intake, body mass index, hypertension, diabetes mellitus, and parental history of coronary heart disease (P = 0.02 for trend). High-fit men (most fit 40%) had 68% (95% CI: 0.12, 0.82) and moderate-fit men had 63% (95% CI: 0.17, 0.83) lower risk of stroke mortality when compared with low-fit men (least fit 20%), respectively. Moderate and high levels of cardiorespiratory fitness were associated with lower risk of stroke mortality in men in the Aerobics Center Longitudinal study population.

Risk factors for stroke mortality in men and women: The Busselton Study.

Although there have been a number of prospective studies of risk factors for stroke, the Busselton study remains the only Australian study to report such data. The Framingham stroke risk appraisal function has been evaluated in very few populations. This paper presents results of stroke mortality risk factor analyses from the Busselton study and compares the Busselton risk factor coefficients with those based on Framingham data. Mortality follow-up to 31 December 1993 on 4872 participants in the Busselton Health Survey 1966-1981 was used for Cox proportional hazards regression analysis of risk factors for death from stroke. Risk factors investigated were systolic and diastolic blood pressures, antihypertensive therapy, diabetes, smoking, body mass index, cholesterol, alcohol, coronary heart disease, atrial fibrillation and left ventricular hypertrophy. The average duration of follow-up was 20 years and a total of 213 individuals died from stroke during the follow-up period. Age, systolic blood pressure, antihypertensive therapy, smoking, cholesterol, alcohol (negatively), coronary heart disease and atrial fibrillation were significantly and independently associated with stroke modality rate. The Cox regression coefficients were generally similar to those from the Framingham study, but there were important differences. This report has confirmed age, blood pressure, antihypertensive therapy, smoking, and pre-existing cardiovascular disease and diabetes as important risk factors for stroke. The suggestion of a protective effect from moderate alcohol consumption requires further study. The Framingham stroke risk appraisal function should be validated before being recommended for individual stroke risk assessment in other populations.

Risk factors for stroke mortality in men and women

Risk factors for stroke mortality in men and women

Out-patient antihypertensive drug utilization and stroke mortality. An ecological study

Directly age-standardized rates of out-patient utilization of antihypertensive drugs (antihypertensives, diuretics and beta-blockers) and stroke mortality in men and women (40–79 years of age) were compared over 4 years (1987–1990) in a midwestern (Varmland) and a southern (Skane) province of Sweden and in their 49 (16 + 33) municipalities. In both genders, the stroke mortality and utilization rates of the 3 antihypertensive drug groups, both combined and separate, were higher in Varmland and there were positive correlations between these rates when all 49 municipalities were compared. On the other hand, for each province and each drug group there were municipalities with every possible combination of stroke mortality and antihypertensive drug utilization rates. In addition, antihypertensive drug utilization rates were similar in men and women even though the stroke mortality rates were much lower among the latter. The findings cast doubt on the effectiveness of antihypertensive drug treatment in common practice.

Optimal blood pressure control in treated hypertensive patients. Report from the Department of Health Hypertension Care Computing Project (DHCCP).

We wished to determine the range of treated systolic (SBP) and diastolic blood pressure (DBP) associated with the best survival in hypertensive patients. We conducted a cohort study of patients enrolled in the DoH Hypertension Care Computer Project. Five specialist hypertension clinics (95% of patients) and general practitioners (5%) followed 6214 patients (3070 men and 3144 women) with an average age of 52 years for a mean of 107 months. Total, cardiovascular, ischemic heart disease, (IHD) and stroke mortality were the outcome measures. Age-adjusted relative hazard rates were calculated giving the effect on mortality of systolic or diastolic pressure being higher by 1 mm Hg. In men the optimal level of SBP for all four measures of mortality was the lowest pressure range observed, 92 to 133 mm Hg (median 127). For women the treated SBP range of 96 to 148 mm Hg (median 137) was associated with a low total mortality and also with low to moderate rates for IHD and stroke mortality. Relative hazard rates (P < .001) for IHD mortality were 1.010 for men and 1.013 for women and for stroke mortality were 1.018 and 1.021, respectively. The results were similar in men under and over the age of 60. SBP and DBP tended to be more important in younger than older women. For treated DBP in men, a pressure of 55 to 94 mm Hg (median 87) was associated with a low total mortality. The lowest stroke mortality in men was observed for a DBP range of 55 to 83 mm Hg (median 80) but with a tendency for an increase in IHD mortality. For women DBP < 95 mm Hg (range 55 to 94, median 87) also was associated with a low total mortality. IHD mortality in women was not closely related to treated DBP, relative hazard rate = 1.003, [95% confidence index (CI); 0.990,1.017] but the relative hazard rate for men was 1.011, (95% CI; 1.000, 1.022). The relative hazard rates for treated DBP and stroke were high at 1.035 and 1.028 for men and women, respectively (P < .001). IHD mortality increased in the one third of patients with the greatest fall in DBP on treatment, provided they were not initially in the one-third group with highest untreated DBP. The best overall survival was associated with a treated SBP of < 134 mm Hg in men and < 149 mm Hg in women and a treated DBP of < 95 mm Hg.

Stroke death and unemployment in London.

The aim was to investigate the relationship between social factors and stroke mortality in men and women aged between 45 and 74 years using census and mortality data from 32 London boroughs in 1971 and 1981. Census data from 1971 and 1981 on type of accommodation, density of room occupation, male unemployment rate, and proportion of households without a car were linked with stroke mortality available for each London borough. 32 London boroughs excluding the City of London. The main outcome measures were the association between age adjusted mortality from stroke and the proportion of households with no car, non-ownership of home, in council housing or rented accommodation, male unemployment rate, and living density of more than 1.5 people per room. There was no strong correlation between social variables and stroke mortality in 1971, but strong correlations were found for male stroke mortality in 1981. The highest correlation was with male unemployment (r = 0.64, p less than 0.001) even after adjusting for the proportion of the population born in the Caribbean and Africa (r = 0.56, p less than 0.01). Other social variables were also highly correlated with male stroke mortality: households without a car (r = 0.63, p less than 0.001), living density of more than 1.5 people per room (r = 0.053, p less than 0.001), council housing (r = 0.45, p = 0.01), and rented accommodation (r = 0.36, p = 0.05). After regressing male mortality on unemployment rate the other social variables were no longer significantly correlated with male stroke mortality. In women, the only significant correlation was found in 1981 between stroke mortality and the proportion of families living in council housing (r = 0.34, p = 0.05). Social factors are important indicators of stroke mortality. The major increases in unemployment over the decade may explain the generally stronger association in 1981 compared with 1971. Male stroke mortality increased by 0.062/1000 for every one percent increase in male unemployment (0.054/1000 after adjusting for place of birth).

Family history of stroke as an independent predictor of ischemic heart disease in men and stroke in women.

The major known cardiovascular risk factors, age, cholesterol, blood pressure, cigarette smoking, and diabetes and family history of heart attack, explain only a proportion of cardiovascular disease. In a study of 1,491 men and 1,924 women aged 50-79 years in an upper middle-class Caucasian population in Rancho Bernardo, southern California, who were free of known cardiovascular disease at baseline in 1972-1974 and who were followed for an average of nine years, family history of stroke in any first-degree relative was an independent predictor of ischemic heart disease mortality in men 50-64 years of age (relative risk = 3.3, p less than 0.05) and of stroke mortality in women 50-79 years of age (relative risk = 2.3, p less than 0.05) after controlling for all the above risk factors. In contrast, family history of stroke was not predictive of stroke mortality in men or of ischemic heart disease mortality in women. These results suggest that family history of stroke may be used as a marker for high-risk subjects and to identify and investigate other major genetic or environmental determinants for cardiovascular disease, particularly sex differences.