Comparison of Gender Differences in Intracerebral Hemorrhage in a Multi-Ethnic Asian Population

<div><p>Background</p><p>Intracerebral hemorrhage (ICH) accounts for 10–15% of all first time strokes and with incidence twice as high in the Asian compared to Western population. This study aims to investigate gender differences in ICH patient outcomes in a multi-ethnic Asian population.</p><p>Method</p><p>Data for 1,192 patients admitted for ICH were collected over a four-year period. Multivariate logistic regression was used to identify independent predictors and odds ratios were computed for 30-day mortality and Glasgow Outcome Scale (GOS) comparing males and females.</p><p>Result</p><p>Males suffered ICH at a younger age than females (62.2 ± 13.2 years vs. 66.3 ± 15.3 years; P<0.001). The occurrence of ICH was higher among males than females at all ages until 80 years old, beyond which the trend was reversed. Females exhibited increased severity on admission as measured by Glasgow Coma Scale compared to males (10.9 ± 4.03 vs. 11.4 ± 4.04; P = 0.030). No difference was found in 30-day mortality between females and males (F: 30.5% [155/508] vs. M: 27.0% [186/688]), with unadjusted and adjusted odds ratio (F/M) of 1.19 (P = 0.188) and 1.21 (P = 0.300). At discharge, there was a non-statistically significant but potentially clinically relevant morbidity difference between the genders as measured by GOS (dichotomized GOS of 4–5: F: 23.7% [119/503] vs. M: 28.7% [194/677]), with unadjusted and adjusted odds ratio (F/M) of 0.77 (P = 0.055) and 0.87 (P = 0.434).</p><p>Conclusion</p><p>In our multi-ethnic Asian population, males developed ICH at a younger age and were more susceptible to ICH than women at all ages other than the beyond 80-year old age group. In contrast to the Western population, neurological status of female ICH patients at admission was poorer and their 30-day mortality was not reduced. Although the study was not powered to detect significance, female showed a trend toward worse 30-day morbidity at discharge.</p></div

Percentage of patients with ICH by age and Glasgow Coma Scale (GCS) severity categories in relation to gender at admission.

<p>(A) Males were more likely to get ICH than females in all age groups, except for the age group >80 years. (B) There were no statistically significant gender differences when GCS was categorized into mild, moderate, and severe. Mild GCS impairment is defined as GCS >12, moderate impairment as 9–12 and severe as ≤ 8.</p

Demographics of intracranial hemorrhage patients by gender.

<p>Males developed ICH at a younger age than females (62.2 ± 13.2 vs. 66.3 ± 15.3; P<0.001). Males had a higher occurrence for ICH at all age groups up to 80 years old, beyond which there was a higher occurrence in females. Gender did not interact with ethnicity to cause a difference in ICH.</p

Effects of gender on patient outcomes following intracranial haemorrhage.

<p>There were no differences, even after adjustment, for 30-day mortality and dichotomized GOS score between the genders.</p

Clinical characteristics at admission by gender.

<p>Females had lower eye and verbal components of GCS, overall GCS, and diastolic blood pressure on admission when compared to males. There was otherwise no difference between the genders for clot size, clot location, and background cerebrovascular risk factors (including smoking history, hypertension, diabetes, hyperlipidemia, statin, warfarin and anti-platelet use).</p

Glasgow Outcome Scale (GOS) on discharge.

<p>Differences between the genders for GOS on discharge were not statistically significant. However, females exhibited a trend of poorer GOS scores that could be clinically relevant, even though our study was not powered to detect significance.</p