Sex differences in stroke mortality in Thailand: a National cohort study.

Abdel-Rahman Abdel-Fattah* (Corresponding Author), Tiberiu Pana, Somsak Tiamkao, Kittisak Sawanyawisuth, Narongrit Kasemsap, Mamas A Mamas, Phyo Kyaw Myint

*Corresponding author for this work

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Over half of the growing global stroke-mortality burden is accounted for by the East-Asian-subcontinent alone. Sex differences in stroke-mortality in the Asian population is yet to be assessed in the literature. We aimed to assess the sex-differences in mortality following stroke in a large cohort of Thai-patients.

All stroke admissions between 2004–2015 were included from the Thailand public-health-insurance-database. The association between sex and mortality was assessed in-hospital, at 1 month, 1 year and 5 years, using multivariable Cox-regressions, separately for ischaemic-stroke (IS), haemorrhagic-stroke (HS) and stroke-of-undetermined-type(SUT), adjusting for confounders.

608,890 patients were included: 370,527 patients with IS(60.9%), 173,236 with HS(28.5%) and 65,127 with SUT(10.6%). Women were older than men in all three groups and had higher prevalence of comorbidities. Adjusted hazard-ratios(HRs) of mortality showed women had higher mortality post-IS compared to men (in-hospital: HR: 1.20; 95% CI: 1.17–1.23; 1 month: HR: 1.17; 95% CI: 1.15–1.20; 1 year: HR: 1.10; 95% CI: 1.09–1.12 and 5 years: HR: 1.02; 95% CI: 1.01–1.03). Women also had higher mortality after HS (in-hospital: HR: 1.02; 95% CI: 1.00–1.04; 1 month: HR: 1.08; 95% CI: 1.06–1.10; 1 year: HR: 1.04; 95% CI: 1.03–1.06 and 5 years: HR: 1.09; 95% CI: 1.08–1.11), and SUT (in-hospital: HR: 1.04; 95% CI: 1.03–1.06; 1 month: HR: 1.20; 95% CI: 1.14–1.27; 1 year: HR: 1.14; 95% CI: 1.09–1.18 and 5 years: HR: 1.06; 95% CI: 1.03–1.10).

Compared to men, women were older at time of stroke-diagnosis and had higher burden of stroke risk-factors. Women also had higher mortality after stroke regardless of stroke-type or duration since stroke-onset. Post-IS, excess stroke-mortality in women was greatest during the in-hospital period, whereas excess stroke-mortality increased with time in women who had HS. No clear relationship was found between duration since stroke-onset and mortality in patients who had SUT.
Original languageEnglish
Pages (from-to)1-7
Number of pages7
JournalAnnales de Cardiologie et d'Angéiologie
Issue number1
Early online date1 Feb 2023
Publication statusPublished - 1 Feb 2023

Bibliographical note

AA : primary author, drafting manuscript.

TAP : statistical analysis and supervision.

ST : data acquisition of Thai data, data interpretation.

KS : data acquisition of Thai data, data interpretation.

NK : data acquisition of Thai data, data interpretation.

MAM : supervision, critical revision.

PKM : supervision, senior author critical revision.

PKM is the guarantor.


  • Sex diference
  • Ischemic stroke
  • Haemorrhagic stroke
  • Mortality
  • Asia


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