Key result
Hospital-based studies recruited a significantly higher male-to-female ratio of participants with cerebral small vessel disease compared to community-based studies (1.16 vs 0.79).
Why the study?
Studies reporting sex differences in cerebral small vessel disease incidence and severity recruited more males than females, leaving it unclear whether this reflects sex-specific mechanisms or recruitment bias.
Systematic Review (n=36,910)
Absolute Event Rate: 1.16% vs 0.79%
p-value: p=<0.001
This meta-analysis highlights significant male-to-female ratio differences in SVD research, with more males recruited in hospital-based studies and presenting with moderate to severe SVD, emphasizing the need for sex-stratified data in future research.
Background Cerebral small vessel disease (SVD) is an important cause of acute ischemic stroke and vascular dementia. Several studies recruiting more males than females have reported sex differences regarding SVD incidence and severity, but it is unclear whether this reflects underlying sex-specific mechanisms or recruitment bias. This work aimed to systematically review and meta-analyze potential sex differences in SVD by assessing the male-to-female ratio (M:F) of recruited participants and incidence of SVD, risk factor presence, distribution and severity of SVD features. Methods Full text of 228 studies from four databases of recent systematic reviews on SVD and an independent search of MEDLINE were evaluated against inclusion and exclusion criteria (registered protocol: CRD42020193995). Data from participants with clinical or non-clinical presentations of SVD with radiological evidence of SVD were extracted. Sex ratios of total participants or SVD groups were calculated and differences in sex ratios across time, countries, SVD severity and risk factors for SVD were explored. Results Amongst 123 relevant studies (n = 36,910 participants) including 53 community-based, 67 hospital-based and 3 mixed studies, more males were recruited in hospital-based than in community-based studies (M:F = 1.16 (0.70) vs M:F = 0.79 (0.35), respectively; p <0.001). More males had moderate to severe SVD (M:F = 1.08 (0.81) vs M:F = 0.82 (0.47) in healthy to mild SVD; p <0.001), especially in stroke presentations where M:F was 1.67 (0.53). M:F of recent research (2015-2020) did not differ from that published pre-2015 and no geographical trends were apparent. There were insufficient sex-stratified data to explore M:F and risk factors for SVD. Conclusions Our results highlight differences in male-to-female ratios in SVD that may reflect sex-specific variability in risk factor exposures, study participation, clinical recognition, genuine SVD severity, or clinical presentation and have important clinical and translational implications.
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Jiménez‐Sánchez et al. (2021) conducted a systematic review in Cerebral Small Vessel Disease (SVD) (n=36,910). Hospital-based study setting vs. Community-based study setting was evaluated on Male-to-female (M:F) recruitment ratio (p=<0.001). Hospital-based studies recruited a significantly higher male-to-female ratio of participants with cerebral small vessel disease compared to community-based studies (1.16 vs 0.79).
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