Sex differences in the impact of acute stroke treatment in a population-based study: a sex-specific propensity score approach

Abstract

Purpose We investigated whether sex modifies the association of acute stroke treatment on functional outcome using propensity score (PS) methods to minimize confounding and to explore the differential effects of confounders by sex. Methods We included tissue plasminogen activator (tPA) treated (n = 84) and nontreated ischemic stroke cases (n = 143) from a population-based stroke study (2008–2013). The PS model that estimated the probability of receiving tPA included interactions between sex and treatment predictors. The outcome model included sex, tPA, and their interaction. In addition, sex-specific PS values were included as a continuous covariate and modeled using splines. We compared the results with conventional methods of statistical adjustment. Results Conventional methods of adjustment suggested that women receive greater benefit from tPA than men. After taking into consideration that the influence of confounders, specifically age and stroke severity, differed by sex, we found no sex difference in the tPA-functional outcome association (P= .94). Conclusions Using PS methods that considered confounding of the sex × treatment interaction, we did not find that the association of tPA with functional outcome differed for women and men. Our findings may have implications for the methodologic approaches used to address confounding in studies that seek to compare stroke treatment effects by sex.

Sex and gender differences in acute stroke care: metrics, access to treatment and outcome. A territorial analysis of the Stroke Code System of Catalonia

“…These findings are consistent with much of the previous literature, suggesting that certain bio-psycho-social factors that affect the subacute phase have an important influence on functional recovery. [31][32][33] It is possible that older age in women with stroke, emotional impact, greater depression, the degree of social and family support, or even access to rehabilitation therapies, may explain these differences in long-term evolution. These aspects need to be thoroughly investigated to plan interventions aimed at minimizing gender differences in stroke recovery.…”

Parameters Affecting Stroke Severity and Outcome in Acute Stroke Patients Treated With Iv Thrombolysis

“…In our study, there was no difference between ratios of males and females who had favorable outcome at one week following thrombolysis treatment (NIHSS diff.≥ 6; 56.5% in men versus 43.5% in women; p=0.61). In a pooled analysis of three major randomized clinical trials of IV r-tPA, Kent et al showed that the proportion of males and females with good functional outcomes at 90 days following treatment was similar, whereas among the placebo group, significantly fewer women had good outcomes (15).…”