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Title: | Sex differences in causes of death after stroke: Evidence from a national, prospective registry. | Authors: | Anderson C.S.;Cadilhac D.A.;Kilkenny M.F.;Castley H.C.;Grimley R.;Lannin N.A.;Thrift A.G. ;Kim J.;Phan H.T.;Gall S.;Blizzard C.L. | Institution: | (Phan, Gall, Blizzard) Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia (Phan) Department of Public Health Management, Pham Ngoc Thach University of Medicine, Ho Chi Minh, Vietnam (Phan, Thrift, Kim, Grimley, Kilkenny, Cadilhac) Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia (Lannin) Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia (Lannin) Alfred Health, Melbourne, Australia (Anderson) Faculty of Medicine, The George Institute for Global Health, The University of New South Wales, Sydney, Australia (Kim, Kilkenny, Cadilhac) Stroke Theme, The Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC, Australia (Grimley) Sunshine Coast Clinical School, University of Queensland, Birtinya, Australia (Castley) Neurology Department, Royal Hobart Hospital, Hobart, Australia | Issue Date: | 18-Mar-2021 | Copyright year: | 2021 | Publisher: | Mary Ann Liebert Inc. | Place of publication: | United States | Publication information: | Journal of Women's Health. 30 (3) (pp 314-323), 2021. Date of Publication: March 2021. | Journal: | Journal of Women's Health | Abstract: | Background: We examined sex differences in cause of death and cause-specific excess mortality after stroke. Material(s) and Method(s): 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. Result(s): 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 (sHRunadjusted 1.65) and other CVD (sHRunadjusted 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 (SMRage-standardised women 8.8; men 8.3). Excess mortality from other CVD was greater in women (SMRage-standardised 3.6 vs. men 2.8; p = 0.026). Conclusion(s): 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.© Copyright 2021, Mary Ann Liebert, Inc., publishers 2021. | DOI: | http://monash.idm.oclc.org/login?url= http://monash.idm.oclc.org/login?url=http://dx.doi.org/10.1089/jwh.2020.8391 |
PubMed URL: | 33227218 [http://www.ncbi.nlm.nih.gov/pubmed/?term=33227218] | ISSN: | 1540-9996 | URI: | https://repository.monashhealth.org/monashhealthjspui/handle/1/26947 | Type: | Article | Subjects: | major clinical study male malignant neoplasm *mortality multicenter study outcome assessment priority journal prospective study Queensland risk factor secondary prevention *sex difference skin cancer urinary tract cancer antihypertensive agent/dt [Drug Therapy] fibrinolytic agent/dt [Drug Therapy] fibrinolytic agent/iv [Intravenous Drug Administration] hypertension/dt [Drug Therapy] adult age aged article atrial fibrillation cardiovascular disease *cause of death *cerebrovascular accident/dt [Drug Therapy] *cerebrovascular accident/ep [Epidemiology] Charlson Comorbidity Index controlled study dementia diabetes mellitus disease severity emergency care female fibrinolytic therapy heart failure hospital discharge human hyperlipidemia International Classification of Diseases ischemic heart disease dementia diabetes mellitus disease severity age female fibrinolytic therapy heart failure hospital discharge human hyperlipidemia hypertension / drug therapy International Classification of Diseases ischemic heart disease major clinical study male malignant neoplasm *mortality multicenter study outcome assessment priority journal prospective study Queensland risk factor secondary prevention *sex difference skin cancer adult emergency care aged Article atrial fibrillation cardiovascular disease *cause of death *cerebrovascular accident / *drug therapy / *epidemiology Charlson Comorbidity Index controlled study urinary tract cancer |
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