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(Stroke. 2009;40:1038.)
© 2009 American Heart Association, Inc.

Go Red for Women

Sex Differences in Incidence, Mortality, and Survival in Individuals With Stroke in Scotland, 1986 to 2005

James D. Lewsey, PhD; Michelle Gillies, MBChB; Pardeep S. Jhund, MBChB; Jim W.T. Chalmers, MBChB; Adam Redpath, MA; Andrew Briggs, DPhil; Matthew Walters, MD; Peter Langhorne, PhD; Simon Capewell, MD; John J.V. McMurray, MD Kate MacIntyre, MD

From Public Health and Health Policy (J.D.L., M.G., P.S.J., A.B., K.M.), BHF Glasgow Cardiovascular Research Centre (P.S.J., J.J.V.M.), and Cardiovascular and Medical Sciences (M.W., P.L.), University of Glasgow, Glasgow, UK; Information Services Division (J.W.T.C., A.R.), Edinburgh, UK; and the Department of Public Health (S.C.), University of Liverpool, Liverpool, UK.

Correspondence to Kate MacIntyre, MD, Public Health and Health Policy, University of Glasgow, Glasgow G12 8RZ, UK. E-mail k.macintyre{at}clinmed.gla.ac.uk

Background and Purpose— The aim of this study was to examine the effect of sex across different age groups and over time for stroke incidence, 30-day case-fatality, and mortality.

Methods— All first hospitalizations for stroke in Scotland (1986 to 2005) were identified using linked morbidity and mortality data. Age-specific rate ratios (RRs) for comparing women with men for both incidence and mortality were modeled with adjustment for study year and socioeconomic deprivation. Logistic regression was used to model 30-day case-fatality.

Results— Women had a lower incidence of first hospitalization than men and size of effect varied with age (55 to 64 years, RR=0.65, 95% CI 0.63 to 0.66; 85 years, RR=0.94, 95% CI 0.91 to 0.96). Women aged 55 to 84 years had lower mortality than men and again size of effect varied with age (65 to 74 years, RR=0.79, 95% CI 0.76 to 0.81); 75 to 84 years, RR=0.94, 95% CI 0.92 to 0.95). Conversely, women aged 85 years had 15% higher stroke mortality than men (RR=1.15, 95% CI 1.12 to 1.18). Adjusted risk of death within 30 days was significantly higher in women than men, and this difference increased over the 20-year period in all age groups (adjusted OR in 55 to 64 year olds 1.23, 95% CI 1.14 to 1.33 in 1986 and 1.51, 95% CI 1.39 to 1.63 in 2005).

Conclusions— We observed lower rates of incidence and mortality in younger women than men. However, higher numbers of older women in the population mean that the absolute burden of stroke is greater in women. Short-term case-fatality is greater in women of all ages and, worryingly, these differences have increased from 1986 to 2005.

Key Words: cerebrovascular disease • epidemiology • prognosis • sex