Stroke & Dementia gender disparities: Findings of the Tunisian Information System on Causes of Death

Background

As Tunisia undergoes an epidemiological transition, life expectancy has risen, reaching 79.3 years for women and 74.7 years for men. But this increased longevity in women is associated with a higher susceptibility to age-related pathologies, especially neurological disorders. Despite this, the impact of aging on gender-specific mortality remains underexplored nationally. This study analyzed gender disparities and temporal trends in stroke and dementia mortality in Tunisia.

Methods

We conducted a trend study using records from the National Cause of Death Information System (CDIS)(2015-2022). Death causes were coded according to the ICD-10. As CDIS coverage remained below 80%, we used proportional mortality as the principal indicator. Gender disparities were measured using Absolute Ratios (AR = Female/Male) of these proportions. Standardized proportions were used to describe temporal trends in disparities.

Results

A total of 226,737 documented deaths between 2015 and 2022 were analyzed. In 2022, circulatory diseases were the leading cause of death among Tunisian women (32.8% vs. 27.2% in men; AR = 1.21). Within this category, Stroke proportional mortality showed a progressive female excess with advancing age, peaking at AR = 1.26 among those ≥75 years. Similarly, other nervous system diseases, including Alzheimer’s disease (AR = 1.67) and dementias (AR = 1.50), showed a female predominance in proportional mortality (AR = 1.27 overall). Trend analysis revealed a persistent and increasing female excess in stroke proportional mortality (2015–2022).

Conclusions

Tunisian women show higher proportional mortality from stroke and neurodegenerative diseases. This highlights the need for gender-sensitive policies focused on prevention and control, like screening programs. Strategies should prioritize the management of cardiovascular risk factors in aging women and promote comprehensive neurological health frameworks to mitigate the burden of neurological disorders in Tunisia.

Key messages

• Our findings show a persistent female excess in stroke and dementia mortality in Tunisia, especially at older ages, highlighting the growing gendered burden of neurological diseases.

• Aging and epidemiological transition are amplifying gender disparities in brain health, calling for stronger prevention of cardiovascular risks in older women.