Sex differences in global disability-adjusted life years due to ischemic stroke: findings from global burden of diseases study 2019

 

Abstract

To investigate the sex differences in disability-adjusted life years (DALYs) due to ischemic stroke (IS) by year, location and age. We extracted sex-specific data on DALYs number, age-standardized DALYs rate (ASDR) and all-age DALYs rate of IS by year, location and age from the Global Burden of Diseases study 2019. The estimated annual percentage changes (EAPC) were calculated to evaluate the temporal trend of ASDR. For both sexes, although the ASDR of IS slightly decreased from 1990 to 2019, there has been an 60.3% increase in DALYs number worldwide. Sex difference in DALYs number (men minus women) decreased from − 2.83 million in 1990 to 0.14 million in 2019, while the men to women’s ASDR ratio slightly increased from 1.10 in 1990 to 1.21 in 2019. The sex differences in IS DALYs showed remarkable regional variation. The largest sex differences in DALYs number and ASDR were in China and Vietnam. Middle-aged men had a higher IS DALYs than their age-matched counterparts. High systolic blood pressure accounted for the highest DALYs number in 2019, but the top three attributable risk factors that had the greatest sex differences were tobacco, dietary risk, and alcohol use. Sex differences in IS DALYs varied by year, location and age, mostly attributed to the disproportion of cardiovascular risk factors between sexes. Considering the population growth and aging, it is necessary to monitor the sex difference in IS DALYs in different populations and thus provide evidence for local administration to improve current preventive and management strategies of IS.

Introduction

Ischemic stroke (IS) accounts for almost 70–80% of stroke cases and is a significant cause of mortality and disability in many countries1,2. Sex differences in IS have been well described in several clinical and epidemiological studies3. Several studies reported that women had higher mortality of IS, a worse functional outcome, and quality of life for IS survivors than men. The sex differences in IS mortality disappeared after adjusting for confounders such as age and risk factors, but persisted for functional outcome and quality-of-life4,5,6. However, a meta-analysis including 19,652 patients showed that women with IS had better survival, but the worse quality of life and more disabilities than men7. Studies have provided a few possible explanations regarding sex disparities, mainly in the aspects of risk profiles, hormone levels, and the pathophysiology of brain injury8. Additionally, other factors, such as race and socioeconomic status, may also affect the sex disparity of IS1. A better understanding of sex disparities in IS may call for improved preventive and therapeutic strategies.

Disability-adjusted life years (DALYs) is a widely used metric to assess the disease burden integrating both mortality (years of life lost [YLLs]) and disability (years lived with disability [YLDs])9. The updated global burden of disease (GBD) 2019 study reported the DALYs number due to IS was increasing. However, discussion regarding the temporal and spatial trends in the sex distribution of IS DALYs is sparse. Therefore, we aimed to provide updated data on the sex difference in IS DALYs using GBD 2019 data.

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