No sex differences in long-term functional outcome after intracerebral hemorrhage

Abstract

Background There is conflicting evidence about the influence of sex on outcome after spontaneous intracerebral hemorrhage (sICH) and the majority of the research focused on mortality and short-term outcome only. We investigated sex differences in long-term functional outcome after sICH. Methods We used data from a prospective hospital registry and included all consecutive patients with ICH admitted to our institution between January 2006 and July 2014. Functional outcome was assessed by modified Rankin Scale evaluated 3 and 12 months after ICH. We explored the influence of sex on long-term functional outcome using multivariable regression models and additionally by means of propensity score matching. Results We analyzed 823 patients, of whom 380 (46%) women. Women were on average three years older (p < 0.001), men had more often deep hematomas (p = 0.01). Unadjusted mortality rates were significantly increased in women at three months (42% vs. 35%; odds ratio (OR): 1.35; 95% confidence interval (CI): 1.02-1.80). After adjusting for baseline prognostic factors there were no differences between men and women in short- and long-term mortality (OR = 1.01; 95% CI = 0.66-1.54 and OR = 1.04; 95%CI = 0.69-1.57, respectively) and short- and long-term unfavorable outcome (OR = 1.02; 95%CI = 0.67-1.55 and OR = 0.96; 95% CI = 0.62-1.48, respectively). Conclusion We found no sex-related differences in long-term functional outcome in patients with sICH. The apparently worse functional outcome in women can be explained by differences in age.

A Population-Based Study of Intracerebral Hemorrhage Survivors’ Outcomes

“…This finding is contrary to our prior studies of ischemic stroke, which identified sex disparities in post stroke QOL, as well as functional and neurologic outcomes 18 ,. 32 , 33 Our findings are corroborated by recent studies which reported no sex-related difference in long term functional outcomes or adjusted poor outcomes following ICH 12 ,. 13 One population-based study from China identified worse functional outcomes in females 3 months after ICH, this difference did not persist at 6 and 12 months 37 .…”

Confounding by Pre-Morbid Functional Status in Studies of Apparent Sex Differences in Severity and Outcome of Stroke

“…One study did not find any difference in post stroke functional status using Barthel Index at 6 months after adjusting for prestroke disability and comorbidities,28 while another still found a worse functional status at 3 months in women in multivariate analysis adjusting for pre-morbid mRS but methodological differences may explain this result 26. A recent study on functional outcome after intracerebral hemorrhage also did not show any sex-difference in adjusted analyses including age and premorbid mRS among other factors 29. Finally, it remains possible that inconsistencies between studies are partly related to the lack of precision of the mRS scale and our conclusions may not apply to other disability or handicap scales.…”

Stroke in women — from evidence to inequalities

“…Other studies have shown no such difference 100 , and extrapolation of results is difficult as confounding factors such as access to acute care or rehabilitation should also be taken into account.…”