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Stroke Deaths and The Link with Gender Inequality

For a variety of reasons, the prevalence of stroke is higher in women than it is in men. Globally, the highest burden of stroke lies with women in low- and middle-income countries. A new study in Lancet looked at whether stroke outcomes varied in countries with more or less gender inequality.

References:

1. GBD 2013 Mortality and Causes of Death Collaborators. Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2015;385:117–171.2.Kim YD, Jung YH, Caso V, et al. Countries with women inequalities have higher stroke mortality. Int J Stroke. 2017;12:869-874.https://www.researchgate.net/publication/314026551_Countries_with_women_inequalities_have_higher_stroke_mortality

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Lack of domestic violence legislation. . . inequalities in getting a job. . . inability to open a bank account and to own property: all are linked to a higher prevalence of stroke in women.

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• Women have a higher prevalence of stroke than men, related to longer life expectancy, disparities in stroke prevention, differences in stroke mechanisms.
• Globally, the highest burden of stroke lies with women in low- and middle-income countries.1
• Stroke outcomes differ based on gender, and may be related to social, environmental or legal gender inequalities in the countries where women live.

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The study looked at 176 countries with age-standardized data on stroke mortality in 2008 and compared female-to-male mortality ratios and stroke mortality rates in women and men. Researchers used 50 indices of women’s right from Women, Business and the Law 2016 and the Gender Inequality Index (GII) 2008 from the United Nations Development Programme. Indices covered access to institutions, financial credit and jobs, protecting women from violence, providing incentives to work, and property rights.

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In 26.1% of countries, stroke mortality rate was higher in women than men; of these, 63% were in Sub-Saharan Africa followed by East Asia and Pacific, Europe and Central Asia, and Middle East, and North Africa. The female-to-male stroke mortality ratio was significantly higher in countries with greater gender inequality (p<0.001). The analysis included 137 countries with available 2008 GII data.

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The female-to-male stroke mortality ratio and stroke mortality rate in women were significantly lower in high-income countries vs low-to middle income countries (both p<0.001). After adjusting for country income, higher female-to-male stroke mortality ratio was associated with 14 indices of women’s rights. Key among these were lack of domestic violence legislation, and inequalities in getting a job, opening a bank account, and property ownership rights.

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Study results describe an association, but cannot determine that gender inequality causes increased stroke mortality in women vs men. The study could not evaluate gender inequalities in stroke disability. Data sources were for 2008; sensitivity analysis using 2014 GII data similarly showed significantly higher stroke mortality rate in women vs. men (p<0.001).

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“Our study should be seen as the first step in the understanding of the potential role of social inequalities, and how differences in women’s rights may influence stroke mortality,” lead author Gustavo Saposnik, MD, University of Toronto, and colleagues with the Women’s Disparities Working Group

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The key points:

1. Study of gender inequalities and stroke mortality found that 26.1% of 176 countries had a stroke mortality rate that was higher in women than men.
2. The female-to-male stroke mortality ratio was significantly higher in countries with greater gender inequality.

3. After adjusting for country income, a higher female-to-male stroke mortality ratio was associated with 14 indices of women’s right, especially lack of domestic violence legislation, and inequalities in getting a job, opening a bank account, and rights to own property.

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