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Lifetime risk of common neurological diseases in the elderly population
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  • Published on: 16 January 2019
    Author reply: Higher burden of common neurological diseases in women than in men
    • Silvan Licher, MD, PhD Student Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
    • Other Contributors:
      • M. Kamran Ikram, Neurologist, Associate Professor of Neuroepidemiology
      • M. Arfan Ikram, Professor of Epidemiology

    Dear Editor,

    We thank Abat et al. for re-emphasizing an important interpretation of our work, namely that sex-differences in life-expectancy likely influenced the presented lifetime risks [1]. Indeed, in our paper we repeatedly discussed in several sections (for instance in the methods) that differences in life-expectancy between men and women could differentially affect their lifetime risk. It was for this reason that we consequently decided to analyze the data in a sex-specific manner while taking the competing risk of death into account in order to prevent potential overestimation.

    Abat et al. unfortunately also allege that we attributed the observed sex-differences in disease risk to sex-specific effects on a biological level. The authors have seemingly missed our discussion at length arguing that observed differences in lifetime risk may be primarily attributed to the effects of differences in life-expectancy between men and women: “Apart from a longer life-expectancy in general, these findings may be explained by smaller differences in life-expectancy between men and women in the Netherlands (1.8 years), compared with the USA (4.8 years). With longer life-expectancy, individuals in this study simply had more time to develop these diseases in a timeframe with high age-specific incidence rates.”

    It seems thus that ours and Abat and co-authors’ interpretation of our findings is pretty much congruent, i.e. age, irrespective of sex, should be consid...

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    Conflict of Interest:
    None declared.
  • Published on: 16 January 2019
    Higher burden of common neurological diseases in women than in men: it is because women live longer!
    • cédric Abat, PhD Aix Marseille Univ, IRD, APHM, MEPHI, IHU-Méditerranée Infection, 19-21 boulevard Jean Moulin, 13005 Marseille, France
    • Other Contributors:
      • yanis roussel, PhD student
      • Didier raoult, University professor and clinician

    To the Editor,
    We read with interest the work from Licher et al. [1] in which the authors tried to quantify the burden of common neurological diseases (i.e. dementia, stroke and parkinsonism) in 12 102 individuals (6 982 women and 5 120 men) aged ≥ 45 years and free from these diseases at baseline. All these individuals were recruited between 1990 and 2016 into the prospective population-based Rotterdam Study. At the end of their analyzes, the authors concluded that one in two women and one in three men will develop dementia, stroke or parkinsonism during their lifetime, and that the risk for women to develop both stroke and dementia during their life is almost twice that of men [1].
    By reading the article from Licher et al. [1], we were extremely surprised by the fact that the authors did not consider the impact of the difference in life expectancies between men and women on their results and conclusions. This is particularly well underlined by the fact that the authors did not clearly precise the age structures of the two populations they studied [1]. In our view, this information is critical as, although the reasons for this difference are still debated and may probably be multi-factorial [2], it is well known that women live longer than men. This trend is confirmed by the 2018 World Health Statistics report [3] that estimates that in 2016, the life expectancies of men and women at birth were respectively 69.8 and 74.2 years at the international level. The...

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    Conflict of Interest:
    None declared.