| Autor: |
Phan HT; Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia.; Department of Public Health Management, Pham Ngoc Thach University of Medicine, Hồ Chí Minh, Vietnam.; Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia., Gall S; Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia., Blizzard CL; Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia., Lannin NA; Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia.; Alfred Health, Melbourne, Australia., Thrift AG; Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia., Anderson CS; Faculty of Medicine, The George Institute for Global Health, The University of New South Wales, Sydney, Australia., Kim J; Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia.; Stroke Theme, The Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia., Grimley R; Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia.; Sunshine Coast Clinical School, University of Queensland, Birtinya, Australia., Castley HC; Neurology Department, Royal Hobart Hospital, Hobart, Australia., Kilkenny MF; Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia.; Stroke Theme, The Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia., Cadilhac DA; Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia.; Stroke Theme, The Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia. |
| Abstrakt: |
Background: We examined sex differences in cause of death and cause-specific excess mortality after stroke. Materials and Methods: First-ever strokes (2010-2013; 35 hospitals) participating in the Australian Stroke Clinical Registry were linked to national death registrations and other administrative datasets. One-year cause-specific mortality was categorized as stroke, ischemic heart disease, other cardiovascular disease (CVD; e.g. , hypertension), cancer, and other. Specific hazard ratios (sHRs) of death for women compared to men were estimated using competing risk models, with adjustment for factors differing by sex ( e.g. , age and stroke severity). Age- and sex-specific mortality rates expected in the general population were derived from national data. Standardized mortality ratios (SMRs; observed/expected deaths) were estimated for cause-specific mortality by sex after age standardization. Results: Among 9,441 cases (46% women), women were 7 years older than men, had more severe strokes, and received similar patterns of suboptimal secondary prevention medications at discharge. Women had greater mortality associated with stroke (sHR unadjusted 1.65) and other CVD (sHR unadjusted 1.65), which was related to age and stroke severity rather than other factors. Compared to population norms, those surviving to 30 days had eight-fold increased mortality from stroke (primary/recurrent) events irrespective of sex (SMR age-standardised women 8.8; men 8.3). Excess mortality from other CVD was greater in women (SMR age-standardised 3.6 vs. men 2.8; p = 0.026). Conclusions: Cause-specific mortality after first-ever stroke differs by sex. The greater death rate attributed to stroke/other CVD in women was mostly explained by age and stroke severity. Greater implementation of secondary stroke prevention is relevant to both sexes. |
