IMPACT OF SEX AND GENDER IN STROKE IN SOUTH-AND-SOUTHEAST ASIA: A RAPID SCOPING REVIEW.

IF 2.2 3区 医学 Q3 CLINICAL NEUROLOGY Cerebrovascular Diseases Pub Date : 2024-10-14 DOI:10.1159/000542010
Rinita Mascarenhas, Dorcas B C Gandhi, Jaime Angeles Sesgundo, Veena Babu, Vinita Elizabeth Mani, Ivy Anne Sebastian
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Abstract

Background: South Asia and Southeast Asia account for more than 40% of the global stroke burden, with differences in stroke risk factors, mortality, and outcomes compared to high-income countries. Socio-cultural norms compound the pre-existing biological risk differences, resulting in a disproportionate burden of stroke in women in this region. This review summarizes the sex and gender differences across the stroke care continuum in South Asia and Southeast Asia over the past 20 years.

Summary: Despite a higher incidence of stroke in men than women in South-and-Southeast Asia, women have greater stroke severity and poorer outcomes after stroke. Higher levels of pre-morbid disability and poor physical health at baseline may be contributory. There is a high prevalence of vascular risk factors such as hypertension, dyslipidemia, cardiac sources of embolism, as well as metabolic syndrome and insulin resistance, among the women in this region. Smoking is uncommon among women, however other forms of smokeless tobacco (SLT), such as tobacco leaf and betel nut chewing are more prevalent, especially in the rural areas in these countries. Women are more likely to have delayed presentations to the hospital due to untimely recognition of stroke symptoms, however, with regards to door-to-needle times or intravenous thrombolysis (IVT) rates, we found equivocal data. Wide gaps exist in stroke awareness and healthcare-seeking behaviors, with women more commonly opting for public hospitals and low-cost wards, more likely to discontinue treatment, and less likely to adhere to post-stroke rehabilitation.

Key findings: This review exposes the gender lacunae in stroke service provision across South Asia and Southeast Asia while acknowledging the many knowledge gaps in our understanding. Although the biological risk differences are non-modifiable, educational, policy, and economic measures to mitigate socio-cultural barriers are much needed in the region. Sound epidemiological data is needed from more countries to better understand these differences and bridge this gap. It is imperative to advocate and implement policies and programs for stroke care viable for women, cognizant of the gender and cost bias, as well as the interplay of social and cultural structures specific to the regions.

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南亚和东南亚中风的性别影响:快速范围界定综述。
背景:南亚和东南亚占全球中风负担的 40% 以上,与高收入国家相比,它们在中风风险因素、死亡率和预后方面存在差异。社会文化规范加剧了原有的生理风险差异,导致该地区女性卒中负担过重。本综述总结了过去 20 年来南亚和东南亚地区在中风治疗过程中的性别差异。摘要:尽管南亚和东南亚地区男性中风发病率高于女性,但女性中风严重程度更高,中风后的预后更差。病前残疾程度较高和基线身体健康状况较差可能是原因之一。在该地区,高血压、血脂异常、心源性栓塞以及代谢综合征和胰岛素抵抗等血管风险因素在女性中的发病率很高。吸烟在妇女中并不常见,但其他形式的无烟烟草(SLT),如咀嚼烟叶和槟榔则更为普遍,尤其是在这些国家的农村地区。由于未能及时发现中风症状,女性更有可能延迟到医院就诊,然而,在门到针的时间或静脉溶栓(IVT)率方面,我们发现数据并不明确。女性更常选择公立医院和低价病房,更有可能中断治疗,更不可能坚持卒中后的康复治疗:本综述揭示了南亚和东南亚地区在提供中风服务方面存在的性别缺陷,同时也承认我们的认识还存在许多知识空白。尽管生理风险差异是不可改变的,但该地区亟需采取教育、政策和经济措施来减少社会文化障碍。需要更多国家提供可靠的流行病学数据,以更好地了解这些差异并缩小这一差距。当务之急是倡导并实施适合女性的中风护理政策和计划,同时认识到性别和成本偏差,以及各地区特有的社会和文化结构的相互作用。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Cerebrovascular Diseases
Cerebrovascular Diseases 医学-临床神经学
CiteScore
4.50
自引率
0.00%
发文量
90
审稿时长
1 months
期刊介绍: A rapidly-growing field, stroke and cerebrovascular research is unique in that it involves a variety of specialties such as neurology, internal medicine, surgery, radiology, epidemiology, cardiology, hematology, psychology and rehabilitation. ''Cerebrovascular Diseases'' is an international forum which meets the growing need for sophisticated, up-to-date scientific information on clinical data, diagnostic testing, and therapeutic issues, dealing with all aspects of stroke and cerebrovascular diseases. It contains original contributions, reviews of selected topics and clinical investigative studies, recent meeting reports and work-in-progress as well as discussions on controversial issues. All aspects related to clinical advances are considered, while purely experimental work appears if directly relevant to clinical issues.
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