Sex Differences in the Incidence of Hemorrhagic and Ischemic Stroke among Diabetics in Taiwan
Sex Differences in the Incidence of Hemorrhagic and Ischemic Stroke among Diabetics in Taiwan
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DOI：
10.1089/jwh.2008.0918
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发表时间：
2009-05-01
影响因子：
3.5
通讯作者：
Li, Chung-Yi
中科院分区：
文献类型：
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作者：
Chen, Hua-Fen;Lee, Siu-Pak;Li, Chung-Yi
背景：糖尿病是卒中的一个重要危险因素，但是否存在性别差异的风险尚未完全阐明。本研究旨在探讨性别对台湾糖尿病人群中出血性及缺血性中风发病率及相对风险的影响。方法：本研究以1997年至2002年间住院的500868名糖尿病患者及500248名年龄及性别匹配的非糖尿病患者为研究对象，以确定因非创伤性出血性及缺血性中风而住院的人数。用泊松假设计算发病密度，用Kaplan-Meier分析评估6年随访期间的累积发病率。结果：女性糖尿病患者出血性卒中的发生率除85岁外均低于男性，但男性和女性之间的差异无统计学意义。女性糖尿病患者的出血性中风和缺血性中风的危险比(HR)分别增加1.2和1.32，显著高于男性糖尿病患者。进一步的年龄分层分析显示，青年和中年糖尿病女性倾向于有较高的HR，而35岁的糖尿病女性的HR尤其高(出血性中风的HR 7.69，95%可信区间1.81~32.75，缺血性卒中的HR 8.46，95%CI 4.28~16.75)。此外，年轻的台湾糖尿病患者最容易受到出血性和缺血性中风相对风险增加的影响。应在年轻糖尿病患者中强调全面的糖尿病护理和卒中预防措施，以防止过早残疾。
Background: Diabetes mellitus is an important risk factor for stroke, but whether there is differential gender-specific risk has not been fully elucidated. We aimed to explore the impact of gender on incidence and relative risks of hemorrhagic and ischemic stroke among the diabetic population in Taiwan.Methods: In this study, 500,868 diabetic patients and 500,248 age matched and-sex-matched nondiabetic individuals were linked to inpatient claims (1997-2002) to identify hospitalizations for nontraumatic hemorrhagic and ischemic stroke. Incidence density was calculated with the Poisson assumption, and Kaplan-Meier analysis was used to assess the cumulative incidence over a 6-year follow-up period. We also evaluated the relative hazards of stroke in relation to diabetes with the Cox proportional hazard model, adjusted with demographics and geographic regions.Results: The incidence of hemorrhagic stroke in diabetic women was less than that in diabetic men except in those aged >= 85, but the difference between male and female diabetic patients was less pronounced with ischemic stroke. The hazard ratios (HRs) of hemorrhagic and ischemic stroke among diabetic women were increased by a magnitude of 1.2 and 1.32, respectively, which were significantly higher than those of diabetic men. Further age-stratified analysis indicated that young and middle-aged diabetic women tended to have higher HRs and that diabetic women aged < 35 suffered from particularly high HRs (HR 7.69, 95% confidence interval [CI] 1.81-32.75 for hemorrhagic stroke, and HR 8.46, 95% CI 4.28-16.75 for ischemic stroke).Conclusions: There was a significant gender-diabetes interactive effect on the incidence of hemorrhagic and ischemic stroke. Additionally, young Taiwanese diabetic patients were most vulnerable to an increased relative risk of hemorrhagic and ischemic stroke. Comprehensive diabetic care with stroke prevention measures should be emphasized in young diabetic people in order to prevent premature disability.