Exploring gender distribution in patients with acute stroke: A multi‑national approach

Background: Gender distribution of acute stroke patients varies considerably among stroke registries throughout the world, but factors responsible for this phenomenon remained vastly unknown. Materials and Methods: Using data from prospective hospital‑based stroke registries in China (n = 752 acute stroke patients), Germany (n = 96054), India (n = 1500), and Iran (n = 1392), this descriptive study explored gender distribution of stroke patients and its determinants. In addition, the proportions of males and females to be expected in fictive study populations were calculated, and differences in gender distribution between stroke databases throughout the world were described. Results: In the German dataset, a maximum male preponderance was found for patients aged between 55 and 64 years (proportion of male patients 0.67 [95% CI: 0.66-0.67]), whereas patients older than 84 years revealed a strong overbalance of females (0.27 [0.26-0.28]). In Germany, age‑specific gender distribution of stroke patients is well explained by the numbers of females and males in the general population and by gender‑specific stroke incidence rates. Both in China and India, a strong preponderance of male stroke patients was found for the majority of age categories with a maximum proportion of male patients of 0.82 in the 35-44 years age group. In contrast, the Iranian stroke register revealed an overbalance of females (0.13 [0.11-0.14]) in nearly all age categories. A total of 1392 Iranian ischemic stroke patients (738 female, 654 male) were investigated. Conclusion: Gender distribution of acute stroke patients is highly variable. Gender distribution varied considerably between countries. Apart from demographic factors reflecting gender ratio in the general population and gender‑specific stroke incidence rates, sociocultural peculiarities may also play an important role in this context.