Heterogeneity among women with stroke: health, demographic and healthcare utilization differentials

Abstract

Background Although age specific stroke rates are higher in men, women have a higher lifetime risk and are more likely to die from a stroke. Despite this increased severity, most studies focus on male/female differences in stroke onset, patterns of care and stroke-related outcomes. Given that stroke presents differently in men and women, mixed sex studies fail to fully capture heterogeneity among women with stroke and the subsequent impact on their outcomes. This study examined the sociodemographic characteristics, factors related to stroke incidence and post-stroke functional status between young (< 60) and old (≥ 60) women with stroke. Methods Using 5 years of data from the National Health Interview Survey (NHIS), a nationally representative sample of US adults, cohorts of young and old women with stroke were identified. A set of demographic/lifestyle, health services utilization and health status characteristics were used evaluate within gender heterogeneity in three ways. First, disparities in population characteristics were assessed using Chi-Square and t tests. Second, young and old women with stroke were matched with women without stroke in their respective cohorts to determine differences in factors related to stroke incidence. Finally, the determinants of post-stroke functional limitation for the two cohorts were determined. Results Young women with stroke were more likely to be Black, smoke regularly and frequently consume alcohol than older women. Young women were also less likely to engage with their health provider regularly or receive preventative health screenings. Diabetes, high blood pressure, high cholesterol and high BMI were correlated with an increased relative likelihood of stroke among older women. In contrast, family size, smoking frequency, alcohol consumption and sleep were correlated with an increased prevalence of stroke among young women. Although factors correlated with stroke varied between young and old women, health status and receipt of healthcare were the most significant determinants of post-stroke functional status for both cohorts. Conclusions Health related characteristics were the primary correlates of stroke in older women, whereas post-stroke lifestyle and behaviors are the most significant correlates for younger stroke survivors. These findings suggest that while receipt of health services is essential for preventing stroke in both young and old women, providers should stress the importance of post-stoke lifestyle and behaviors to younger women at risk of stroke using approaches that may be different from older stroke women.

Sex-Specific Differences in Pre-Stroke Characteristics Reveal Vulnerability of Elderly Women

“…In light of the increasing prevalence of this disorder in women of advanced age [ 25 ] and recent work implicating that hypertension is associated with greater stroke risk in women than in men [ 26 ], effective treatment and control of hypertension is an essential component for stroke prevention in elderly women. A recent study identified important differences between young and older women regarding risk and lifestyle factors associated with stroke incidence and post-stroke functional impairment, necessitating age-dependent differential approaches in secondary and tertiary stroke prevention [ 27 ]. With all other vascular risk factors more frequently found in men aged >70–≤90 years, it is not surprising that strokes caused by large and small vessel disease show a distinct male predominance.…”

Stroke Severity among Men and Women Acute Ischemic Stroke Patients in the Telestroke Network

“…The total number of strokes is higher, and the outcomes are worse among women. This is due to women typically living longer and stroke risk increasing with age [ 28 , 29 , 30 ]. In addition, women present with more severe neurologic impairments following a stroke and are less likely to receive acute stroke therapies and have worse functional outcomes after hospitalizations [ 31 ].…”

Factors affecting length of hospital stay in stroke survivors in South Africa: A call for a stroke unit

“…This is similar to findings of an existing South African study that highlighted a higher prevalence of strokes among females (Ferris & Naicker 2020 ). Despite age-specific stroke rates being higher in males, females are more at risk of having more stroke events that they are less likely to recover from because of their longer life expectancy (Girijala et al 2017 ; Jacobs & Ellis 2021 ; Reeves et al 2008 ). These current findings are also comparable to a study conducted at CHBAH, which found ischaemic strokes more prevalent in women than men (Mudzi et al 2012 ).…”