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BACKGROUND AND PURPOSE: Stroke mortality worldwide has decreased in men and women in most industrialized countries, except in eastern European countries. The purpose of this study was to compare the sex ratio of stroke mortality between populations and over time. This approach may help to determine the factors influencing this ratio. METHODS: The sex ratios (men to women) of stroke mortality between ages 55 to 64, 65 to 74, and 75 to 84 years from 27 populations between 1955 and the latest available year were analyzed using World Health Organization data. The relationship between log stroke mortality and age and the relationships between alcohol, animal fat, cigarette consumption, and urinary cation excretion and the sex ratio of stroke mortality were also analyzed. RESULTS: The mean sex ratio of stroke mortality increased 50%, 34%, and 15% in the three age classes, respectively, over 35 years. Highly significant relationships of log stroke mortality with age exist, which vary between men and women and among countries. In general, stroke mortality changed in the same direction in both sexes but decreased earlier and more rapidly in women than in men. Alcohol consumption and urinary sodium excretion correlated positively and significantly with the sex ratio. The time trends of the sex ratio also correlated positively and significantly with the time trends of cigarette consumption. No relationship with animal fat consumption was found. CONCLUSIONS: The sex ratio of stroke mortality is increasing with time and decreasing with age. Differences in lifestyle among countries and over the last three decades may contribute partially to these differences in sex ratio.
Zhang et al. (Sun,) studied this question.