Gender Differences in Stroke Incidence and Poststroke Disability in the Framingham Heart Study

Abstract

Background and Purpose-Stroke is emerging as a major public health problem for women, as it is for men. Controversy persists regarding gender differences in stroke incidence, severity, and poststroke disability. Methods-Participants in the Framingham Original (nϭ5119; 2829 women) and Offspring (nϭ4957, 2565 women) cohorts who were 45 years and stroke-free were followed to first incident stroke. Gender-specific outcome measures were adjusted for the Framingham Stroke Risk Profile components. Results-We observed 1136 incident strokes (638 in women) over 56 years of follow-up. Women were significantly (PϽ0.001) older (75.1 versus 71.1 years for men) at their first-ever stroke, had a higher stroke incidence above 85 years of age, lower at all other ages, and a higher lifetime risk of stroke at all ages. There was no significant difference in stroke subtype, stroke severity, and case fatality rates between genders. Women were significantly (PϽ0.01) more disabled before stroke and in the acute phase of stroke in dressing (59% versus 37%), grooming (57% versus 34%), and transfer from bed to chair (59% versus 35%). At 3 to 6 months poststroke women were more disabled, more likely to be single, and 3.5 times more likely to be institutionalized (PϽ0.01). Conclusions-These results from the Framingham Heart Study (FHS) support the existence of gender-differences in stroke incidence, lifetime risk (LTR) of stroke, age at first stroke, poststroke disability, and institutionalization rates. Prestroke disability and sociodemographic factors may contribute to the high rate of institutionalization and poorer outcome observed in women.

Subjective health complaints predict functional outcome six months after stroke

“…A basic question, especially concerning age, is whether the apparent associations are due to ageing itself or secondary to other causes. Regarding sex, previous researchers have generally reported a negative effect of female sex on functional outcome 5, 19, 20, 21, 22, 23, 24, 25, 26, 27. This is seen also in the present study (for details, see11).…”

Breastfeeding History and Risk of Stroke Among Parous Postmenopausal Women in the Women's Health Initiative

“…Although this study's findings could not establish a causal relationship between breastfeeding and risk of stroke, health disparities surrounding stroke1, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18 and breastfeeding rates52, 53, 54 persist. Stroke is 1 of the leading causes of death among Hispanic and non‐Hispanic black women over 65 2, 4.…”

“…Stroke costs the nation $34 billion annually including the cost of healthcare services, medications, and lost productivity 1. Approximately 55 000 more US women than men suffer from a stroke annually 1, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16. Compared with elderly men, elderly female stroke survivors are also at increased risk for moderate to severe disability, poorer quality of life, and institutionalization 16, 17…”

“…Stroke is higher among Hispanics and non‐Hispanic blacks compared with non‐Hispanic whites 1, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 18. Hispanic and non‐Hispanic black women are at higher risk of stroke, partially due to increased rates of hypertension, obesity, diabetes mellitus, and physical inactivity,1, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28 which are a few stroke risk factors.…”

Trends in Acute Ischemic Stroke Hospitalizations in the United States

“…Numerous studies have shown that men have higher stroke incidence than women in younger and middle‐age groups, but these differences narrow in older age groups and reverse in the elderly 11, 12, 13, 14, 15, 16. Recent studies have suggested declining stroke incidence in both men and women.…”