Amin Amiri1, Moira K Kapral2, Amanda G Thrift3, Luciano A Sposato4, Hamidreza Saber5, Reza Behrouz6, Mahdiyeh Erfanian7, Mohammad Taghi Farzadfard1, Naghmeh Mokhber8, Mahmoud Reza Azarpazhooh9. 1. Department of Neurology, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran. 2. Department of Medicine and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences and Toronto General Research Institute, Toronto, Ontario, Canada. 3. Stroke and Ageing Research, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia; Stroke Division, Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia. 4. Department of Clinical Neurological Science, University Hospital, London Health Science Center, University of Western Ontario, London, Ontario, Canada; Stroke, Dementia & Heart Disease Laboratory, Western University, London, Ontario, Canada. 5. Department of Neurology, Wayne State University School of Medicine, Detroit, Michigan. 6. Department of Neurology, School of Medicine, University of Texas, Health Science Center, San Antonio, Texas. 7. Department of Statistics, Faculty of Mathematical Sciences, Ferdowsi University of Mashhad. 8. Department of Psychiatry & Behavioural Neurosciences, Western University, London, Ontario, Canada; Department of Psychiatry, Mashhad University of Medical Sciences, Mashhad, Iran. 9. Department of Neurology, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran; Department of Clinical Neurological Science, University Hospital, London Health Science Center, University of Western Ontario, London, Ontario, Canada; Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada. Electronic address: reza.azarpazhooh@lhsc.on.ca.
Abstract
BACKGROUND: Population-based data regarding stroke among women are scarce in developing countries. This study was designed to determine whether sex differences exist in stroke incidence, mortality, and recurrence. METHODS: The Mashhad Stroke Incidence Study is a population-based cohort study in Iran. For a period of 1 year, all patients with stroke in 3 geographical regions in Mashhad were recruited and then followed up for 5 years. Age- and sex-specific crude incidence rates were standardized to the World Health Organization New World Population. Male-to-female incidence rate ratios were assessed for all age groups and all subtypes of first-ever stroke (FES). RESULTS: The annual crude incidence rate of FES (per 100,000 population) was similar in men (144; 95% confidence interval [CI]: 129-160) and women (133; 95% CI: 119-149). Standardized FES annual incidence rates were 239 (95% CI: 213-267) for men and 225 (95% CI 200-253) for women, both greater than in most western countries. There were no significant differences in stroke recurrence or case-fatality between women and men during early and long-term follow-up. CONCLUSION: The similar incidence of stroke between men and women highlights the importance of equally prioritizing adequate preventive strategies for both sexes. The greater relative incidence of stroke in women in Mashhad compared with other countries warrants improvement of primary and secondary stroke prevention.
BACKGROUND: Population-based data regarding stroke among women are scarce in developing countries. This study was designed to determine whether sex differences exist in stroke incidence, mortality, and recurrence. METHODS: The Mashhad Stroke Incidence Study is a population-based cohort study in Iran. For a period of 1 year, all patients with stroke in 3 geographical regions in Mashhad were recruited and then followed up for 5 years. Age- and sex-specific crude incidence rates were standardized to the World Health Organization New World Population. Male-to-female incidence rate ratios were assessed for all age groups and all subtypes of first-ever stroke (FES). RESULTS: The annual crude incidence rate of FES (per 100,000 population) was similar in men (144; 95% confidence interval [CI]: 129-160) and women (133; 95% CI: 119-149). Standardized FES annual incidence rates were 239 (95% CI: 213-267) for men and 225 (95% CI 200-253) for women, both greater than in most western countries. There were no significant differences in stroke recurrence or case-fatality between women and men during early and long-term follow-up. CONCLUSION: The similar incidence of stroke between men and women highlights the importance of equally prioritizing adequate preventive strategies for both sexes. The greater relative incidence of stroke in women in Mashhad compared with other countries warrants improvement of primary and secondary stroke prevention.