Gender differences in mortality after hospital admission for stroke

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.

A nationwide cohort of patients with a first admission for stroke and stroke subtypes was identified through linkage of national registers. Age- and 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.

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).

Women have lower 28-day case-fatality and long-term 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.