Gender Differences in Mortality after Hospital Admission for Stroke

Background: Differences between men and women in stroke symptoms, management and disability have been reported to be unfavorable for women. Yet, studies into differences between men and women in survival after a stroke yielded inconsistent results. We investigated whether gender was associated with all-cause mortality after hospital admission for stroke. Methods: A nationwide cohort of patients with a first admission for stroke and stroke subtypes was identified through linkage of national registers. Ageand gender-specific mortality risks were quantified for 28-day case-fatality, 1-year and 5-year periods. Cox regression models were used to adjust for potential confounding factors. Results: We identified 30,675 stroke patients (15,925 women, 14,750 men). In ischemic-stroke patients, 28-day case-fatality, 1-year and 5-year mortality risk (hazard ratio (HR) 0.90; 95% confidence interval (CI) 0.85 to 0.95, HR 0.88; 95% CI 0.84 to 0.92, HR 0.84; 95% CI 0.81 to 0.88, respectively) and in intracerebral-hemorrhage patients, 1-year and 5-year mortality risks (HR 0.92; 95% CI 0.86 to 0.99) were lower for women compared to men after adjustment for age and previous admissions for cardiovascular diseases or diabetes mellitus. In subarachnoid hemorrhage patients, no differences between men and women in crude and adjusted mortality risks were observed. When all stroke types were combined, differences in mortality risk between men and women were seen, and appeared to differ by age (increased risk in young women, lower risk in older women). Conclusions: Women have lower 28-day case-fatality and longterm mortality risks after an ischemic stroke and lower 1-year and 5-year mortality risks after an intracerebral hemorrhage compared to men, whereas no differences in mortality risks were found for subarachnoid hemorrhage. Copyright (C) 2009 S. Karger AG, Base

Nationwide incidence of first stroke and TIA in the Netherlands

Information on incidence of stroke is important for developing and maintaining public health strategies in primary and secondary prevention. Nationwide data on the incidence of stroke are scarce and absent for the Netherlands. New cases of first stroke and stroke subtypes in the Dutch population in 2000 were identified through linkage of national registers and included hospitalized patients for first stroke and out-of-hospital deaths from first stroke. The number of non-fatal, non-hospitalized stroke patients was estimated based on data from the Rotterdam study, a population based cohort. We identified 26 556 patients with a first stroke (20 798 hospitalized patients, 5758 out-of-hospital deaths). The number of non-fatal, non-hospitalized first stroke patients was estimated to be 12 255. Extrapolation of the data to the total Dutch population led to an overall estimate of approximately 41 000 patients with a first stroke. Stroke incidence increased with age and was higher in men than in women, except in the lowest ( 85 years). The present study provides for the first time incidence estimates of first stroke (hospitalized patients, out-of hospital deaths and non-fatal, non-hospitalized patients) based upon virtually the entire Dutch population

Risk of death after first admission for cardiovascular diseases by country of birth in The Netherlands: a nationwide record-linked retrospective cohort study

OBJECTIVE: To examine differences in short- (28 days) and long-term (5 years) risk of death in patients hospitalised for the first time for various cardiovascular diseases (CVD) by country of birth and/or parental country of birth. DESIGN: A nationwide prospective cohort of CVD patients. Settings: Entire Netherlands. PATIENTS: 118 691 patients hospitalised for the first time for various CVDs were identified through the national hospital discharge, the Dutch population and the cause-of-death registers. MAIN OUTCOME MEASURES: Differences in short-term and long-term risk of death. Cox proportional hazard models were used to estimate the mortality hazard ratios. RESULTS: After adjusting for age, compared with Dutch patients, Turkish, other non-Western and Western migrants had both a short- and long-term higher risk, while Suriname patients had only a long-term higher risk of total-mortality and combined-CVD mortality. These higher rates were driven mainly by an increased risk of short-term (hazard ratio 3.21; 95% CI 1.03 to 10.03) and long-term (2.29; 1.14 to 4.60) mortality following congestive heart failure (CHF) among Turkish; short-term (1.56; 1.10 to 2.20) and long-term (1.50; 1.11 to 2.01) mortality following cerebrovascular accident (CVA) among the other non-Western migrants; short-term mortality following CVA (1.10; 1.01 to 1.19) and long-tem mortality following CVA (1.10; 1.03 to 1.17), and, to a lesser extent, CHF and myocardial infarction among Western migrants; and a long-term mortality following CVA (1.29; 1.05 to 1.57) among Surinamese patients. CONCLUSION: Higher mortality after a first episode of CVD was found in ethnic minority patients than in Dutch patients. These differences hardly changed after adjusting for possible confounders, suggesting that treatment and secondary prevention strategies may be less effective in these groups. More research is needed to explain the possible causes of these inequalitie