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

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.

研究背景：南亚与东南亚地区承担了全球超40%的脑卒中（stroke）负担，该地区脑卒中的危险因素、死亡率及预后与高收入国家存在显著差异。社会文化规范进一步加剧了既有的生物学风险差异，导致该地区女性承受了不成比例的脑卒中负担。本综述总结了过去20年间南亚与东南亚地区脑卒中照护全流程（stroke care continuum）中的性别差异。

研究综述：尽管南亚与东南亚地区男性脑卒中发病率高于女性，但女性脑卒中后的病情严重程度更高、预后更差。病前残疾程度更高及基线健康状况较差可能是相关诱因。该地区女性群体中，高血压（hypertension）、血脂异常（dyslipidemia）、心源性栓塞源（cardiac sources of embolism）等血管危险因素，以及代谢综合征（metabolic syndrome）与胰岛素抵抗（insulin resistance）的患病率均较高。女性群体中主动吸烟的情况并不多见，但咀嚼烟叶、槟榔等其他形式的无烟烟草（SLT）更为普遍，尤其在这些国家的农村地区。由于未能及时识别脑卒中症状，女性更易出现就医延迟；但在入院到溶栓时间（door-to-needle times）或静脉溶栓（IVT）率方面，现有数据结果并不明确。该地区在脑卒中认知与就医行为方面存在显著差距：女性更倾向于选择公立医院与低价病房，更易中断治疗，且依从脑卒中后康复（post-stroke rehabilitation）的比例更低。

主要研究发现：本综述揭示了南亚与东南亚地区脑卒中服务供给中的性别缺口，同时也承认目前我们对该领域的认知仍存在诸多空白。尽管生物学层面的风险差异无法改变，但该地区亟需通过教育、政策与经济手段来缓解社会文化层面的阻碍。未来需从更多国家获取可靠的流行病学数据，以更好地理解这些差异并填补认知空白。鉴于该地区特有的社会文化结构与性别、成本偏见及其相互影响，亟需倡导并实施适配女性的脑卒中照护政策与项目。