Abstract：
BACKGROUND: Aneurysmal subarachnoid hemorrhage (SAH) is more common in women than in men, contrary to most cardiovascular diseases. However, it is unclear whether the case fatality rate (CFR) of SAH also differs by sex. Thus, we performed a systematic review to address the relationship between sex and SAH CFRs.
METHODS: We conducted a systematic literature search in PubMed, Scopus, and Cochrane library databases. We focused on population-based studies that included both nonhospitalized and hospitalized SAHs and had either reported 1-month (28-31 day) SAH CFRs separately for men and women or calculated risk estimates for SAH CFR by sex. For quality classification, we used the Cochrane Collaboration Handbook and Critical Appraisal Skills Program guidelines. We pooled the study cohorts and calculated relative risk ratios (RRs) with 95% confidence intervals (CIs) for SAH death between women and men using a random-effects meta-analysis model.
RESULTS: The literature search yielded 5,592 initial publications, of which 33 study cohorts were included in the final review. Of the 33 study cohorts, only three reported significant sex differences, although the findings were contradictory. In the pooled analysis of all 53,141 SAH cases (60.3% women) from 26 countries, the 1-month CFR did not differ (RR = 0.99 [95% CI: 0.93-1.05]) between women (35.5%) and men (35.0%). According to our risk-of-bias evaluation, all 33 study cohorts were categorized as low quality. The most important sources of bias risks were related to the absence of proper confounding control (all 33 study cohorts), insufficient sample size (27 of 33 study cohorts), and poor/unclear diagnostic accuracy (27 of 33 study cohorts).
CONCLUSIONS: Contrary to SAH incidence rates, the SAH CFRs do not seem to differ between men and women. However, since none of the studies were specifically designed to examine the sex differences in SAH CFRs, future studies on the topic are warranted.
METHODS: We conducted a systematic literature search in PubMed, Scopus, and Cochrane library databases. We focused on population-based studies that included both nonhospitalized and hospitalized SAHs and had either reported 1-month (28-31 day) SAH CFRs separately for men and women or calculated risk estimates for SAH CFR by sex. For quality classification, we used the Cochrane Collaboration Handbook and Critical Appraisal Skills Program guidelines. We pooled the study cohorts and calculated relative risk ratios (RRs) with 95% confidence intervals (CIs) for SAH death between women and men using a random-effects meta-analysis model.
RESULTS: The literature search yielded 5,592 initial publications, of which 33 study cohorts were included in the final review. Of the 33 study cohorts, only three reported significant sex differences, although the findings were contradictory. In the pooled analysis of all 53,141 SAH cases (60.3% women) from 26 countries, the 1-month CFR did not differ (RR = 0.99 [95% CI: 0.93-1.05]) between women (35.5%) and men (35.0%). According to our risk-of-bias evaluation, all 33 study cohorts were categorized as low quality. The most important sources of bias risks were related to the absence of proper confounding control (all 33 study cohorts), insufficient sample size (27 of 33 study cohorts), and poor/unclear diagnostic accuracy (27 of 33 study cohorts).
CONCLUSIONS: Contrary to SAH incidence rates, the SAH CFRs do not seem to differ between men and women. However, since none of the studies were specifically designed to examine the sex differences in SAH CFRs, future studies on the topic are warranted.
摘要：
背景：动脉瘤性蛛网膜下腔出血（SAH）在女性中比在男性中更常见，与大多数心血管疾病相反。然而,尚不清楚SAH的病死率(CFR)是否因性别而异.因此，我们对性别与SAHCFRs之间的关系进行了系统评价.
方法：我们在PubMed，Scopus,和Cochrane图书馆数据库。我们专注于基于人群的研究，包括非住院和住院SAHs，并分别报告了男性和女性1个月（28-31天）的SAHCFR，或按性别计算了SAHCFR的风险估计。对于质量分类，我们使用了Cochrane协作手册和关键评估技能计划指南.我们汇总了研究队列，并使用随机效应荟萃分析模型计算了男女SAH死亡的相对风险比（RR）和95％置信区间（CI）。
结果：文献检索产生了5,592篇初始出版物，其中33个研究队列被纳入最终审查.在33个研究队列中，只有三个人报告了显著的性别差异，虽然调查结果是矛盾的。在对来自26个国家的所有53,141例SAH病例（60.3%为女性）的汇总分析中，女性(35.5%)和男性(35.0%)的1个月CFR没有差异(RR=0.99[95%CI0.93-1.05]).根据我们的偏见风险评估，所有33个研究队列被归类为低质量.偏倚风险的最重要来源与缺乏适当的混杂控制有关（所有33个研究队列），样本量不足(33个研究队列中有27个)，和差/不清楚的诊断准确性（33个研究队列中的27个）。
结论：与SAH发病率相反，男性和女性的SAHCFR似乎没有差异.然而,由于没有一项研究是专门为检查SAHCFR的性别差异而设计的，有必要对该主题进行未来的研究。
方法：我们在PubMed，Scopus,和Cochrane图书馆数据库。我们专注于基于人群的研究，包括非住院和住院SAHs，并分别报告了男性和女性1个月（28-31天）的SAHCFR，或按性别计算了SAHCFR的风险估计。对于质量分类，我们使用了Cochrane协作手册和关键评估技能计划指南.我们汇总了研究队列，并使用随机效应荟萃分析模型计算了男女SAH死亡的相对风险比（RR）和95％置信区间（CI）。
结果：文献检索产生了5,592篇初始出版物，其中33个研究队列被纳入最终审查.在33个研究队列中，只有三个人报告了显著的性别差异，虽然调查结果是矛盾的。在对来自26个国家的所有53,141例SAH病例（60.3%为女性）的汇总分析中，女性(35.5%)和男性(35.0%)的1个月CFR没有差异(RR=0.99[95%CI0.93-1.05]).根据我们的偏见风险评估，所有33个研究队列被归类为低质量.偏倚风险的最重要来源与缺乏适当的混杂控制有关（所有33个研究队列），样本量不足(33个研究队列中有27个)，和差/不清楚的诊断准确性（33个研究队列中的27个）。
结论：与SAH发病率相反，男性和女性的SAHCFR似乎没有差异.然而,由于没有一项研究是专门为检查SAHCFR的性别差异而设计的，有必要对该主题进行未来的研究。
