Sex differences in stroke mortality in Thailand:  a National cohort study.

Abdel-Rahman Abdel-Fattah; Tiberiu Pana; Somsak  Tiamkao; Kittisak  Sawanyawisuth; Narongrit Kasemsap; Mamas A Mamas; Phyo Kyaw Myint

doi:10.1016/j.ancard.2022.11.003

Sex differences in stroke mortality in Thailand: a National cohort study.

Abdel-Rahman Abdel-Fattah^* (Corresponding Author), Tiberiu Pana, Somsak Tiamkao, Kittisak Sawanyawisuth, Narongrit Kasemsap, Mamas A Mamas, Phyo Kyaw Myint

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

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Abstract

Background
Over 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.

Method
All 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.

Results
608,890 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).

Conclusions
Compared 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.

Original language	English
Pages (from-to)	1-7
Number of pages	7
Journal	Annales de Cardiologie et d'Angéiologie
Volume	72
Issue number	1
Early online date	1 Feb 2023
DOIs	https://doi.org/10.1016/j.ancard.2022.11.003
Publication status	Published - 1 Feb 2023

Bibliographical note

Acknowledgements
AA : primary author, drafting manuscript.

TAP : statistical analysis and supervision.

ST : data acquisition of Thai data, data interpretation.

KS : data acquisition of Thai data, data interpretation.

NK : data acquisition of Thai data, data interpretation.

MAM : supervision, critical revision.

PKM : supervision, senior author critical revision.

PKM is the guarantor.

Keywords

Sex diference
Ischemic stroke
Haemorrhagic stroke
Mortality
Asia

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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Cite this

@article{fdad37c40679400b82a8fc1c8daf66a7,

title = "Sex differences in stroke mortality in Thailand: a National cohort study.",

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.",

keywords = "Sex diference, Ischemic stroke, Haemorrhagic stroke, Mortality, Asia",

author = "Abdel-Rahman Abdel-Fattah and Tiberiu Pana and Somsak Tiamkao and Kittisak Sawanyawisuth and Narongrit Kasemsap and Mamas, {Mamas A} and Myint, {Phyo Kyaw}",

note = "Acknowledgements AA : primary author, drafting manuscript. TAP : statistical analysis and supervision. ST : data acquisition of Thai data, data interpretation. KS : data acquisition of Thai data, data interpretation. NK : data acquisition of Thai data, data interpretation. MAM : supervision, critical revision. PKM : supervision, senior author critical revision. PKM is the guarantor.",

year = "2023",

month = feb,

day = "1",

doi = "10.1016/j.ancard.2022.11.003",

language = "English",

volume = "72",

pages = "1--7",

journal = "Annales de Cardiologie et d'Ang{\'e}iologie",

issn = "0003-3928",

publisher = "Elsevier",

number = "1",

}

TY - JOUR

T1 - Sex differences in stroke mortality in Thailand

T2 - a National cohort study.

AU - Abdel-Fattah, Abdel-Rahman

AU - Pana, Tiberiu

AU - Tiamkao, Somsak

AU - Sawanyawisuth, Kittisak

AU - Kasemsap, Narongrit

AU - Mamas, Mamas A

AU - Myint, Phyo Kyaw

N1 - Acknowledgements AA : primary author, drafting manuscript. TAP : statistical analysis and supervision. ST : data acquisition of Thai data, data interpretation. KS : data acquisition of Thai data, data interpretation. NK : data acquisition of Thai data, data interpretation. MAM : supervision, critical revision. PKM : supervision, senior author critical revision. PKM is the guarantor.

PY - 2023/2/1

Y1 - 2023/2/1

N2 - 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.

AB - 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.

KW - Sex diference

KW - Ischemic stroke

KW - Haemorrhagic stroke

KW - Mortality

KW - Asia

U2 - 10.1016/j.ancard.2022.11.003

DO - 10.1016/j.ancard.2022.11.003

M3 - Article

SN - 0003-3928

VL - 72

SP - 1

EP - 7

JO - Annales de Cardiologie et d'Angéiologie

JF - Annales de Cardiologie et d'Angéiologie

IS - 1

ER -