Background and Aims: Aortic dissection (AD) management requires early medical therapy and surgical intervention in applicable patients with type A aortic dissection (TAAD) or complicated type B dissection (TBAD). We aimed to assess incidence trends of AD in Sweden, and sex-based differences in management and outcome over 25 years. Methods: Swedish National Patient Register and Cause of Death Register were used to identify new AD between 1999 and 2023. Incidence, management and survival outcomes were analysed with relative survival comparing general population matching age, sex and year. Results: 15946 individuals had AD, 12225 admitted alive, and 6595 (53.9%) treated medically. Of 5630 surgically treated, 4141 (73.6%) represented TAAD; 1489 (26.4%) represented TBAD. Incidence increased significantly to 9.32/100,000, annual percentage change (APC) 1.4% (95%CI 1.2-1.6%). Incidence was lower for women (6.25/100,000) than men (10.52), but incidence increased threefold in women (APC 2.3% 95% CI 1.9-2.6%) than men (0.8% 95% CI 0.5-1.0%). Women presented older (mean 71.9 years; men 67.5 years, p < 0.001), had less surgical treatment (37.8% AD; 33.6% of surgical TAAD; 29.3% of surgical TBAD, p < 0.001) and poorer 10 year relative survival (medical: women 70.9%; men 84.1% p = 0.0041, surgical TAAD: women 86.6% men 94.9% p < 0.0001, surgical TBAD: women 70.9%; men 87.5% p = 0.027). Conclusion: This nationwide population-based study confirms increasing incidence of AD in Sweden, with persisting sex disparities in management, short- and long-term outcomes. These findings underscore needs for targeted interventions improving diagnosis, management and prognostication of AD, especially in women.