Sex Differences in Stroke Survival: 10-Year Follow-up of the Copenhagen Stroke Study Cohort

Background: Although diverging, most studies show that sex has no significant influence on stroke survival. Methods: In a Copenhagen, Denmark, community all patients with stroke during March 1992 to November 1993 were registered on hospital admission. Stroke severity was measured using the Scandinavian Stroke Scale (0-58); computed tomography determined stroke type. A risk factor profile was obtained for all including ischemic heart disease, hypertension, diabetes mellitus, atrial fibrillation, previous stroke, smoking, and alcohol consumption. Date of death was obtained within a 10-year follow-up period. Predictors of death were identified using a Cox proportional hazards model. Results: Of 999 patients, 559 (56%) were women and 440 (44%) were men. Women were older (77.0 v 70.9 years; P < .001) and had more severe strokes (Scandinavian Stroke Scale: 36.1 v 40.5; P < .001). Age-adjusted risk factors showed no difference between sexes for ischemic heart disease, hypertension, atrial fibrillation, diabetes mellitus, and previous stroke. Men more often were smokers and alcohol consumers. Unadjusted survival in men and women did not differ: 70.3% versus 66.7% (1-year), 40.0% versus 38.9% (5-year), and 17.4% versus 18.7% (10-year), respectively. Adjusting for age, stroke severity, stroke type, and risk factors, women had a higher probability of survival at 1 year (hazard ratio 1.47, 95% confidence interval 1.10-2.00); 5 years (hazard ratio 1.47, 95% confidence interval 1.23-1.76); and 10 years (hazard ratio 1.49, 95% confidence interval 1.28-1.76). Before 9 months poststroke, no difference in survival was seen. Severity of stroke had the same effect on sex. Conclusion: Stroke is equally severe in men and women. Short-term survival is the same. Having survived stroke, women, however, live longer.