Sex differences in incidence, mortality, and survival in individuals with stroke in Scotland, 1986 to 2005.
OBJECTIVE
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; >or=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 >or=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.
Lewsey
James D
JD
Public Health and Health Policy, University of Glasgow, Glasgow, UK.
Gillies
Michelle
M
Jhund
Pardeep S
PS
Chalmers
Jim W T
JW
Redpath
Adam
A
Briggs
Andrew
A
Walters
Matthew
M
Langhorne
Peter
P
Capewell
Simon
S
McMurray
John J V
JJ
Macintyre
Kate
K
D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D012606:Scotland / Q000453:epidemiology; D012727:Sex Characteristics; D017678:Sex Distribution; D020521:Stroke / Q000401:mortality*