Sex difference in specific-cause mortality after stroke: The australian stroke clinical registry.

Background and Aims: All-cause mortality after stroke is greater in women than men. Our aim was to examine whether there are sex differences in the causes of death (COD) or the potential contributing factors. Method(s): 1-year COD were obtained by linking first-ever strokes (2010- 2013) admitted to 35 hospitals participating in the Australian Stroke Clinical Registry to national death registrations. COD were categorised as stroke, ischemic heart disease (IHD), other cardiovascular disease (CVD, e.g. hypertension), cancer, and other causes. Competing risk models were used to estimate female:male specific hazard ratios (sHRs) of death with adjustment for factors that differed between men and women (sociodemographics, stroke severity assessed by ability to walk on admission). Result(s): Among 9,441 events (46% women), women were 7 years older (median age 78 vs 72, p<0.001) than men, had more severe stroke (32% vs 41% able to walk on admission, p<0.001), received similar acute care therapies, and had greater all-cause mortality (25.4% vs 19.1% p<0.001). Women had greater risk of death due to stroke (sHRunadjusted 1.65, 95% CI 1.42-1.91) and other CVD (sHRunadjusted 1.65, 95% CI 1.29-2.12), but these differences were substantially attenuated after adjusting for age, stroke severity (stroke: sHRadjusted 1.19, 95% CI 1.02-1.40; other CVD: sHRadjusted 1.12, 95% CI 0.85-1.48). In contrast, women less often died from IHD (sHRadjusted 0.58, 95% CI 0.43+/-0.77), or from cancer (sHRadjusted 0.67, 95% CI 0.49+/-0.91). Conclusion(s): COD after first stroke differ between genders with women having more deaths attributed to stroke or other CVD, reinforcing the need to manage cardiovascular risk factors.