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Updated: Feb 25, 2026
Author Spotlight: Assessing Ischemic Stroke Damage Through Middle Cerebral Artery Occlusion Model
Published on: August 11, 2023
Sex-specific stroke incidence over time in the Greater Cincinnati/Northern Kentucky Stroke Study
Tracy E Madsen1, Jane Khoury2, Kathleen Alwell2
1From the Department of Emergency Medicine (T.E.M.), The Alpert Medical School of Brown University, Providence, RI; Division of Biostatistics and Epidemiology (J.K.), Cincinnati Children's Hospital Medical Center, OH; Neuroscience Institute (J.K., M.L.F., D.W., F.D.L.R.L.R., S.F., O.A., P.K., J.P.B., B.M.K., D.W.), Department of Neurology and Rehabilitation Medicine (K.A., C.J.M., M.L.F., D.W., P.K., J.P.B., B.M.K., D.K.), and Department of Emergency Medicine (O.A.), University of Cincinnati College of Medicine; Institute for Policy Research (E.R.), University of Cincinnati, OH; Department of Neurology (J.M.), Indiana University School of Medicine, Indianapolis; Baptist Health Neuroscience Center (F.D.L.R.L.R.), Miami, FL; and Department of Neurology (S.M.), Michael E. DeBakey VA Medical Center and Baylor College of Medicine, Houston, TX. Tracy_Madsen@brown.edu.
Objective:
Recent data suggest stroke incidence is decreasing over time, but it is unknown whether incidence is decreasing in women and men to the same extent.
Methods:
Within our population of 1.3 million, all incident strokes among residents ≥20 years old were ascertained at all hospitals during July 1993-June 1994 and calendar years 1999, 2005, and 2010. A sampling scheme was used to ascertain out-of-hospital cases. Sex-specific incidence rates per 100,000 among black and white participants, age- and race-adjusted, were standardized to the 2000 US Census population. Trends over time by sex were compared; a Bonferroni correction was applied for multiple comparisons.
Results:
Over the 4 study periods, there were 7,710 incident strokes; 57.2% (n = 4,412) were women. Women were older than men (mean ± SE 72.4 ± 0.34 vs 68.2 ± 0.32, p < 0.001). Incidence of all strokes decreased over time in men (263 [confidence interval 246-281] to 192 [179-205], p < 0.001) but not in women (217 [205-230] to 198 [187-210], p = 0.15). Similar sex differences were seen for ischemic stroke (men, 238 [223-257] to 165 [153-177], p < 0.01; women, 193 [181-205] to 173 [162-184], p = 0.09). Incidence of all strokes and of ischemic strokes was similar between women and men in 2010. Incidence of intracerebral hemorrhage and subarachnoid hemorrhage were stable over time in both sexes.
Conclusions:
Decreases in stroke incidence over time are driven by a decrease in ischemic stroke in men. Contrary to previous study periods, stroke incidence rates were similar by sex in 2010. Future research is needed to understand why the decrease in ischemic stroke incidence is more pronounced in men.
