Sex Disparities in Stroke: Women Have More Severe Strokes but Better Survival Than Men

Dehlendorff, Christian; Andersen, Klaus Kaae; Olsen, Tom Skyhøj

doi:10.1161/jaha.115.001967

Cited by 85 publications

(67 citation statements)

References 33 publications

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“…The covariates examined included age (per 5-year increase above 65), marital status (married/not married), hypertension, diabetes, COPD, history of CAD, AF, anemia, renal dysfunction (estimated glomerular filtration rate <60 mL/min/1.73 m2), time from stroke onset to rehabilitation admission <30 days, ischemic stroke, dysphagia, neglect, motor FIM score at admission, and cognitive FIM score at admission. These variables were selected based on availability at time of presentation and prior studies showing an association with the outcomes of interest (4,6,11,12,17,(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32) and were included in all analyses.…”

Section: Covariatesmentioning

confidence: 99%

Sex Differences in Long-Term Mortality and Functional Outcome After Rehabilitation in Patients With Severe Stroke

et al. 2020

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Objective: We sought to determine sex differences in outcomes in patients with severe stroke who had been admitted to inpatient rehabilitation.Methods: We studied 1,316 patients aged 18 to 99 (mean 72) classified as case-mix groups 0108, 0109, and 0110 of the Medicare case-mix classification system. These groups encompass the most severe strokes. Three outcomes were analyzed: (1) 3-year mortality from admission to rehabilitation; (2) combined outcome of transfer to acute care or death within 90 days from admission to rehabilitation; (3) functional outcome, including proportional recovery in motor functioning and good functional outcome as defined by achievement of a Functional Independence Measure (FIM)-motor score ≥65 points at discharge. Multivariable regression analyses were used to assess sex-difference in each outcome between women and men. The covariates examined included age, marital status, comorbidities, time from stroke onset to rehabilitation admission <30 days, ischemic stroke, dysphagia, neglect, motor FIM score at admission, and cognitive FIM score at admission.Results: Kaplan-Meier estimated 3-year mortality rate was 20.7% in women and 22.0% in men. The crude hazard ratio (HR) of death for women compared with men was 0.94 (95% CI 0.74-1.20). After adjustment for significant covariates, the HR of 3-year mortality was 0.73 (95% CIs 0.56-0.96; p = 0.025). Comorbidity, including diabetes, anemia, coronary artery disease, atrial fibrillation, and chronic obstructive pulmonary disease, significantly increased mortality risk by 49-88%. The incidence of the combined outcome was 8.3% in women and 8.4% in men. The crude HR of the combined end-point for women compared with men was 1.05 (95% CI 0.72-1.53). After adjustment for significant covariates, the HR was 0.95 (95% CIs 0.65-1.40; p = 0.810). Likewise, no significant difference in proportional recovery or in the rate of achievement of a good functional outcome between women and men was observed.Conclusion: Among patients admitted to inpatient rehabilitation after severe stroke, women and men had comparable crude mortality rates at 3 years. After multivariable Scrutinio et al.Sex Differences in Severe Stroke adjustment, however, women had lower mortality risk. No sex-differences in the risk of being transferred to acute care or dying within 90 days from admission to rehabilitation or in responsiveness to rehabilitation were observed.

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Section: Covariatesmentioning

confidence: 99%

Sex Differences in Long-Term Mortality and Functional Outcome After Rehabilitation in Patients With Severe Stroke

et al. 2020

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“…Two large studies based on the Danish stroke registry of first-ever acute stroke reported that women suffered from more severe strokes than men as assessed by the Scandinavian stroke scale [5, 18]. This sex difference was significant in elderly patients in their early 70s even after age and risk factors were adjusted for [18].…”

Section: Sex Differences In Clinical Strokementioning

confidence: 99%

“…This sex difference was significant in elderly patients in their early 70s even after age and risk factors were adjusted for [18]. Stroke etiology, marital status and socioeconomic factors were also taken into account [5]. In contrast, Gall et al did not observe any sex differences in the proportion of severe strokes (National Institutes of Health Stroke Scale, NIHSS >7) after adjusting for confounding factors [19].…”

Section: Sex Differences In Clinical Strokementioning

confidence: 99%

“…In addition, sex did not predict stroke death at 100 days or at 1 year follow-up [31, 32]. However, some studies suggest that mortality might be higher in men for stroke patients above 65 [33] or the mid-70s [5, 18, 20]. In contrast, higher case fatality in women at 3 and 12 months was reported in a large nation-wide Swedish study that included 64,746 stroke patients that was independent on activities of daily living (ADL) prior to the stroke; however, no adjustment was made for differences in baseline demographics [8].…”

Section: Sex Differences In Clinical Strokementioning

confidence: 99%

“…Considerations were made whether data were adjusted for differences in baseline demographics such as age and risk factors, and social factors. Adjusted analysis is important since the risk factor profile is different in male and female stroke patients with atrial fibrillation and hypertension being more common in women while men more frequently have a history of heart disease, smoking and alcohol use [5-8]. If sex differences remain after demographics and social factors have been controlled this speaks for a true biological difference in stroke outcome between men and women.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

The Importance of Considering Sex Differences in Translational Stroke Research

Ahnstedt

McCullough

Cipolla

2016

Transl. Stroke Res.

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Stroke is the second leading cause of death worldwide and differences between men and women have been documented in incidence, prevalence and outcome. Here, we reviewed the literature on sex differences in stroke severity, mortality, functional outcome and response to therapies after ischemic stroke. Many of the sex differences in stroke severity and mortality are explained by differences in baseline demographics such as older age in women. However, women account for more stroke deaths, consistently suffer from worse stroke outcomes and are more often institutionalized and permanently disabled than men. These sex differences in functional outcome are equalized after treatment with tissue plasminogen activator (tPA) and women may benefit more from treatment than men. However this may depend on race, as African American women have less of a response to tPA than other groups. Regarding endovascular treatments, the few existing studies that have investigated sex differences in stroke outcome point to equal benefit in both sexes, however, many clinical trials are relatively underpowered to detect sex differences. Further, we considered sex-specific effects in animal models of stroke and present recommendations for the performance of stroke studies in female animals. The male-biased use of research animals is distinguished from the clinical situation where there is a disproportionate and growing female stroke population. Stroke in women is greatly understudied and including both sexes is especially important in both preclinical and clinical studies that evaluate potential stroke therapies.

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