Sex Differences in Stroke Care and Outcome 2005-2018 Observations From the Swedish Stroke Register
Sex Differences in Stroke Care and Outcome 2005-2018 Observations From the Swedish Stroke Register
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DOI：
10.1161/strokeaha.120.033893
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发表时间：
2021-10-01
期刊：
影响因子：
8.3
通讯作者：
von Euler, Mia
中科院分区：
文献类型：
--
作者：
Eriksson, Marie;Asberg, Signild;von Euler, Mia
背景和目的：瑞典先前关于卒中管理和预后的研究揭示了男性和女性之间的差异。我们的目标是分析中风发病率、护理和结果的差异是否随着时间的推移而改变。方法：纳入2005年至2018年在瑞典卒中登记处登记的所有卒中事件。背景变量和治疗是在急性住院期间收集的。生存数据从全国死因登记中通过个体关联获得。我们使用未调整的比例和估计的年龄调整边际平均值，使用广义线性模型来呈现结果。结果：从2005年到2018年，我们确定了335起183起中风事件，男性和女性的发病率都在下降。男性中风发病时的平均年龄为73.3岁，女性为78.1岁。从2005年到2018年，女性接受再通治疗的年龄调整比例比男性增长更快(男性为2.3%-15.1%，女性为1.4%-16.9%)，但在2018年，女性在30分钟内接受溶栓治疗的可能性仍然较低。在房颤患者中，女性出院时口服抗凝剂的增加更快(男性为31.2%-78.6%，女性为26.7%-81.9%)。他汀类药物在男性中仍然较高(男性为36.9%-83.7%，女性为32.3%-81.2%)。男性卒中后的功能结果和存活率较好。在对女性年龄更高、中风更严重和背景特征进行调整后，功能结果的绝对差异是结论：在瑞典，中风的发生率、护理和结果显示不断改善，之前报道的男性和女性之间的差异变得不那么明显。更严重的中风和女性中风发病时的高龄是对持续差异的解释。
Background and Purpose: Previous studies of stroke management and outcome in Sweden have revealed differences between men and women. We aimed to analyze if differences in stroke incidence, care, and outcome have altered over time. Methods: All stroke events registered in the Swedish Stroke Register 2005 to 2018 were included. Background variables and treatment were collected during the acute hospital stay. Survival data were obtained from the national cause of death register by individual linkage. We used unadjusted proportions and estimated age-adjusted marginal means, using a generalized linear model, to present outcome. Results: We identified 335 183 stroke events and a decreasing incidence in men and women 2005 to 2018. Men were on average younger than women (73.3 versus 78.1 years) at stroke onset. The age-adjusted proportion of reperfusion therapy 2005 to 2018 increased more rapidly in women than in men (2.3%-15.1% in men versus 1.4%-16.9% in women), but in 2018, women still had a lower probability of receiving thrombolysis within 30 minutes. Among patients with atrial fibrillation, oral anticoagulants at discharge increased more rapidly in women (31.2%-78.6% in men versus 26.7%-81.9% in women). Statins remained higher in men (36.9%-83.7% in men versus 32.3%-81.2% in women). Men had better functional outcome and survival after stroke. After adjustment for women's higher age, more severe strokes, and background characteristics, the absolute difference in functional outcome was Conclusions: Stroke incidence, care, and outcome show continuous improvements in Sweden, and previously reported differences between men and women become less evident. More severe strokes and older age in women at stroke onset are explanations to persisting differences.