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Vol. 38, No. 2, 2012
Issue release date: March 2012
Neuroepidemiology 2012;38:69–75

Sex Differences in Stroke Incidence and Survival in Hong Kong, 2000–2007

Wu S.H. · Ho S.C. · Chau P.H. · Goggins W. · Sham A. · Woo J.
aSchool of Public Health and Primary Care and bDepartment of Medicine and Therapeutics, Chinese University of Hong Kong, and cFaculty of Social Sciences, University of Hong Kong, Hong Kong, SAR, PR China

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Background: Few studies have examined the impact of sex across different age groups and over time on chronic diseases in Asia. The objective of this study was to explore the effect of sex across different age groups and over time on stroke incidence and 30-day case fatality in Hong Kong. Methods: Over 90% first hospitalizations for stroke in Hong Kong (from 2000 to 2007) were identified from the Clinical Management System of the Hospital Authority. Age-specific rate ratios (RRs; women to men) for incidence of first hospitalization and the 30-day case fatality were estimated based on Poisson regression models after adjustment for year of hospitalization. Results: Women below the age of 85 years had a lower incidence of first hospitalization than men, and the effect size varied with age [35–44 years: RR = 0.56, 95% confidence interval (CI) = 0.49–0.64; 45–54 years: 0.65, 0.53–0.79; 55–64 years: 0.58, 0.48–0.71; 65–74 years: 0.71, 0.58–0.85; 75–84 years: 0.83, 0.68–1.00)]. Women aged ≧85 years had a stroke incidence similar to men, but the adjusted 30-day case fatality was significantly higher than that of men aged ≧85 years (RR = 1.14, 95% CI = 1.05–1.23). Conclusions: Lower rates of incidence were observed in women than men aged 35–84 years in Hong Kong but short-term case fatality is greater in women aged ≧85 years.

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  1. World Health Organization: World Health Report 2004 – Changing History. Geneva, World Health Organization, 2004.
  2. World Health Organization: Neglected Global Epidemics: Three Growing Threats. Geneva, World Health Organization, 2004.
  3. Department of Health, Hong Kong Government: Vital statistics. 2008.
  4. Appelros P, Stegmayr B, Terent A: Sex differences in stroke epidemiology: a systematic review. Stroke 2009;40:1082–1090.
  5. Lewsey JD, Gillies M, Jhund PS, et al: Sex differences in incidence, mortality, and survival in individuals with stroke in Scotland, 1986 to 2005. Stroke 2009;40:1038–1043.
  6. Sturgeon JD, Folsom AR: Trends in hospitalization rate, hospital case fatality, and mortality rate of stroke by subtype in Minneapolis-St. Paul, 1980–2002. Neuroepidemiology 2007;28:39–45.
  7. Medin J, Nordlund A, Ekberg K, Swedish Hospital Discharge Register: Increasing stroke incidence in Sweden between 1989 and 2000 among persons aged 30 to 65 years: evidence from the Swedish hospital discharge register. Stroke 2004;35:1047–1051.
  8. Carolei A, Marini C, Di Napoli M, et al: High stroke incidence in the prospective community-based L’Aquila registry (1994–1998). First year’s results. Stroke 1997;28:2500–2506.
  9. Stewart JA, Dundas R, Howard RS, Rudd AG, Wolfe CD: Ethnic differences in incidence of stroke: Prospective study with stroke register. BMJ 1999;318:967–971.
  10. Touze E, Rothwell PM: Sex differences in heritability of ischemic stroke: a systematic review and meta-analysis. Stroke 2008;39:16–23.
  11. Reeves MJ, Bushnell CD, Howard G, et al: Sex differences in stroke: epidemiology, clinical presentation, medical care, and outcomes. Lancet Neurol 2008;7:915–926.
  12. Viscoli CM, Brass LM, Kernan WN, Sarrel PM, Suissa S, Horwitz RI: A clinical trial of estrogen-replacement therapy after ischemic stroke. N Engl J Med 2001;345:1243–1249.
  13. Alkayed NJ, Harukuni I, Kimes AS, London ED, Traystman RJ, Hurn PD: Gender-linked brain injury in experimental stroke. Stroke 1998;29:159–165, discussion 166.
  14. McCullough LD, Alkayed NJ, Traystman RJ, Williams MJ, Hurn PD: Postischemic estrogen reduces hypoperfusion and secondary ischemia after experimental stroke. Stroke 2001;32:796–802.
  15. Matteis M, Troisi E, Monaldo BC, Caltagirone C, Silvestrini M: Age and sex differences in cerebral hemodynamics: a transcranial Doppler study. Stroke 1998;29:963–967.
  16. Kardys I, Vliegenthart R, Oudkerk M, Hofman A, Witteman JC: The female advantage in cardiovascular disease: do vascular beds contribute equally? Am J Epidemiol 2007;166:403–412.
  17. Hollander M, Koudstaal PJ, Bots ML, Grobbee DE, Hofman A, Breteler MM: Incidence, risk, and case fatality of first ever stroke in the elderly population. The Rotterdam Study. J Neurol Neurosurg Psychiatry 2003;74:317–321.
  18. Keenan NL, Donehoo RS, Malarcher AM, Mensah GA: Sex differences in US mortality rates for stroke and stroke subtypes by race/ethnicity and age, 1995–1998. Stroke 2002;33:1197–1201.
  19. Chen HF, Lee SP, Li CY: Sex differences in the incidence of hemorrhagic and ischemic stroke among diabetics in Taiwan. J Womens Health (Larchmt) 2009;18:647–654.
  20. Appelros P, Nydevik I, Seiger A, Terent A: Predictors of severe stroke: influence of preexisting dementia and cardiac disorders. Stroke 2002;33:2357–2362.
  21. Mayo NE, Nadeau L, Daskalopoulou SS, Cote R: The evolution of stroke in Quebec: a 15-year perspective. Neurology 2007;68:1122–1127.
  22. Fang J, Alderman MH, Keenan NL, Croft JB: Declining US stroke hospitalization since 1997: national hospital discharge survey, 1988–2004. Neuroepidemiology 2007;29:243–249.
  23. Niewada M, Kobayashi A, Sandercock PA, Kaminski B, Czlonkowska A, International Stroke Trial Collaborative Group: Influence of gender on baseline features and clinical outcomes among 17,370 patients with confirmed ischaemic stroke in the international stroke trial. Neuroepidemiology 2005;24:123–128.
  24. Olsen TS, Dehlendorff C, Andersen KK: Sex-related time-dependent variations in post-stroke survival – evidence of a female stroke survival advantage. Neuroepidemiology 2007;29:218–225.
  25. Kapral MK, Fang J, Hill MD, et al: Sex differences in stroke care and outcomes: results from the registry of the Canadian stroke network. Stroke 2005;36:809–814.
  26. Gargano JW, Wehner S, Reeves M: Sex differences in acute stroke care in a statewide stroke registry. Stroke 2008;39:24–29.
  27. Foerch C, Misselwitz B, Humpich M, et al: Sex disparity in the access of elderly patients to acute stroke care. Stroke 2007;38:2123–2126.
  28. Roquer J, Campello AR, Gomis M: Sex differences in first-ever acute stroke. Stroke 2003;34:1581–1585.
  29. Andersen MN, Andersen KK, Kammersgaard LP, Olsen TS: Sex differences in stroke survival: 10-year follow-up of the Copenhagen stroke study cohort. J Stroke Cerebrovasc Dis 2005;14:215–220.
  30. Woo J, Tang NL, Suen E, Leung JC, Leung PC: Telomeres and frailty. Mech Ageing Dev 2008;129:642–648.

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