Predictors of One-Year Disability and Death in Chinese Hospitalized Women after Ischemic Stroke

Abstract

Background and Purpose: Women have a worse functional outcome after stroke, but the specific factors associated with a poor outcome in women are rarely reported. This study was designed to investigate the clinical predictors of 1-year disability and death in women after ischemic stroke. Methods: Patients with ischemic stroke consecutively registered from March 2002 to July 2007 were followed prospectively for 1 year. Multivariate regression models were employed to analyze predictors of disability (defined as modified Rankin scale score, mRS, 3–5 ) and death. Results: A total of 2,774 ischemic stroke patients were included with 1,119 (40.3%) females (mean age 65 ± 13.5 years). Among female patients, disability (mRS 3–5) is 1.68-fold higher and case fatality is 1.23-fold higher than in men at the 1-year follow-up. Diabetes is an independent predictor of 1-year disability among women (odds ratio, 1.56; 95% confidence interval, CI, 1.01–2.39). In-hospital acute renal failure (hazard ratio, HR, 7.26; 95% CI, 3.47–5.19), suboptimal antiplatelets (HR, 0.55; 95% CI, 0.37–0.83) and antihypertensive therapy (HR, 0.61; 95% CI, 0.42–0.90) are associated with death at 1 year after stroke among women. Conclusions: The present study indicates that diabetes, in-hospital acute renal failure, suboptimal antiplatelets and antihypertensive therapy are the possible explanations for the poor 1-year outcome of women hospitalized with ischemic stroke.

Sex Differences in Long-Term Outcomes After Stroke

“…32,33 There were 4 studies specifically designed to identify sex differences in PADL with all finding females had worse functional outcomes after stroke. 9,13,21,22 All studies adjusted for age, 2 adjusted for stroke severity, 21,22 and 2 adjusted for vascular risk factors. 13,21 Among studies not designed to examine sex differences, 5 reported that females had worse outcome than males in unadjusted analyses 10 and independent of age, 11,16,23,24 stroke severity, 23,24 prestroke disability, 23 comorbidities, 24 depression, 11 living alone, 11 recurrent stroke, 11 and cognitive impairments.…”

“…31 Our synthesis of the literature thus suggests that females have worse functional outcomes in the long term after stroke, but the difference between the sexes is greatly reduced when confounding factors are taken into account. Of the 12 studies that adjusted for at least age and stroke severity, 15,17,18,[21][22][23][24][25][26][27]29,30 4 reported that females had worse outcomes than males, whereas the remainder reported no sex difference. Important covariates appeared to be age, stroke severity, and prestroke functional status.…”

Changes in Functional Outcome Over the First Year After Stroke

“…11,[25][26][27] The results of our study concur with studies that found female sex to be predictive of ADL dependency after stroke. [27][28][29][30][31][32][33] In a systematic review by Gall et al, it was hypothesized that women may be more vulnerable than men to worse outcomes because of differences in demographic, social, and medical histories. 34 In the present study, women were ≈4 years older than men and a slightly higher proportion had atrial fibrillation.…”

Features of Acute Ischemic Stroke With Rheumatic Heart Disease in a Hospitalized Chinese Population

“…Details of the Chengdu Stroke Registry have been described previously. 10,11 In the present study, we included patients admitted within 1 month after stroke onset from January 2003 to February 2007. Patients who refused to participate in the registry and refused to be followed-up were excluded.…”

“…13 Other vascular risk factors surveyed in this study included hypertension, diabetes mellitus, hyperlipidemia, coronary heart disease, previous transient ischemic attacks, history of stroke, and current smoking and alcohol consumption, which have been described in previous reports. 10,11 Stroke severity on admission was measured using the National Institutes of Health Stroke scale (NIHSS). 14 The outcome measures were death, disability, death /disability, and recurrence at 3 months, 6 months, and 1 year after stroke.…”