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Title: Sex Differences in Long-Term Mortality After Stroke in the INSTRUCT (INternational STRoke oUtComes sTudy): A Meta-Analysis of Individual Participant Data.
Austin Authors: Phan, Hoang T;Blizzard, Christopher L;Reeves, Mathew J;Thrift, Amanda G;Cadilhac, Dominique;Sturm, Jonathan;Heeley, Emma;Otahal, Petr;Konstantinos, Vemmos;Anderson, Craig;Parmar, Priya;Krishnamurthi, Rita;Barker-Collo, Suzanne;Feigin, Valery;Bejot, Yannick;Cabral, Norberto L;Carolei, Antonio;Sacco, Simona;Chausson, Nicolas;Olindo, Stephane;Rothwell, Peter;Silva, Carolina;Correia, Manuel;Magalhães, Rui;Appelros, Peter;Kõrv, Janika;Vibo, Riina;Minelli, Cesar;Gall, Seana
Affiliation: Departamento de Neurologia, Psicologia e Psiquiatria, Universidade de São Paulo, Ribeirão Preto, Brazil
UNIFAI, Instituto de Ciências Biomédicas de Abel Salazar, Universidade do Porto, Portugal
Department of Neurology, Faculty of Medicine and Health, Örebro University, Sweden
Department of Neurology and Neurosurgery, University of Tartu, Estonia
From the Menzies Institute for Medical Research Tasmania, University of Tasmania, Hobart, Australia
Department of Health Management and Health Economics, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
Department of Epidemiology and Biostatistics, Michigan State University, East Lansing
Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Heidelberg, Victoria, Australia
Faculty of Health and Medicine, University of Newcastle, New South Wales, Australia
George Institute for Global Health, University of Sydney, New South Wales, Australia
Hellenic Cardiovascular Research Society, Athens, Greece
National Institute for Stroke and Applied Neurosciences, School of Public Health and Psychosocial Studies, Auckland, New Zealand
School of Psychology, University of Auckland, New Zealand
University of Burgundy, Dijon, France
University Hospital of Dijon, France
Clinica Neurológica de Joinville, Joinville Stroke Registry, University of Joinville Region-Univille, Brazil
Department of Biotechnological and Applied Clinical Sciences, Neurological Institute, University of L'Aquila, Italy
Stroke Unit, Centre Hospitalier Sud Francilien, Corbeil-Essonnes, France
Stroke Unit, University Hospital of Bordeaux, France
Stroke Prevention Research Unit, Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, United Kingdom
Issue Date: Feb-2017 2017
Publication information: Circulation. Cardiovascular quality and outcomes 2017; 10(2): e003436
Abstract: BACKGROUND: Women are reported to have greater mortality after stroke than men, but the reasons are uncertain. We examined sex differences in mortality at 1 and 5 years after stroke and identified factors contributing to these differences. METHODS AND RESULTS: Individual participant data for incident strokes were obtained from 13 population-based incidence studies conducted in Europe, Australasia, South America, and the Caribbean between 1987 and 2013. Data on sociodemographics, stroke-related factors, prestroke health, and 1- and 5-year survival were obtained. Poisson modeling was used to estimate the mortality rate ratio (MRR) for women compared with men at 1 year (13 studies) and 5 years (8 studies) after stroke. Study-specific adjusted MRRs were pooled to create a summary estimate using random-effects meta-analysis. Overall, 16 957 participants with first-ever stroke followed up at 1 year and 13 216 followed up to 5 years were included. Crude pooled mortality was greater for women than men at 1 year (MRR 1.35; 95% confidence interval, 1.24-1.47) and 5 years (MRR 1.24; 95% confidence interval, 1.12-1.38). However, these pooled sex differences were reversed after adjustment for confounding factors (1 year MRR, 0.81; 95% confidence interval, 0.72-0.92 and 5-year MRR, 0.76; 95% confidence interval, 0.65-0.89). Confounding factors included age, prestroke functional limitations, stroke severity, and history of atrial fibrillation. CONCLUSIONS: Greater mortality in women is mostly because of age but also stroke severity, atrial fibrillation, and prestroke functional limitations. Lower survival after stroke among the elderly is inevitable, but there may be opportunities for intervention, including better access to evidence-based care for cardiovascular and general health.
DOI: 10.1161/CIRCOUTCOMES.116.003436
ORCID: 0000-0001-8162-682X
PubMed URL: 28228454
Type: Journal Article
Subjects: incidence
Risk Factors
Appears in Collections:Journal articles

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