Sex Disparity in the Access of Elderly Patients to Acute Stroke Care

Abstract

MD; for the Arbeitsgruppe Schlaganfall HessenBackground and Purpose-Sex differences in the management of acute coronary symptoms are well documented. We sought to determine whether sex disparities exist in acute stroke management, particularly with regard to early hospital admission and thrombolytic therapy. Methods-We analyzed a prospective, countywide, hospital-based stroke registry. Between 1999 and 2005, all cases with a final diagnosis of cerebral infarction (ICD-10 I63) or intracerebral hemorrhage (ICD-10 I61) were selected. Datasets with missing values for sex and time to admission, as well as datasets of patients transferred between hospitals in the acute phase, were excluded. Main outcome measures were the probability of being admitted within the first 3 hours of stroke onset and being treated with thrombolytic agents for both women and men, after adjustment for age, prestroke disability, severity of clinical symptoms, vascular risk factors, and final diagnosis. Results-Fifty-three thousand four hundred fourteen patients were included (49.3% female; meanϮSD age, 72.1Ϯ12.5 years). Women had a 10% lower chance of being admitted within the first 3 hours than men (odds ratioϭ0.902, 95% CIϭ0.860 to 0.945, PϽ0.001). This chance further decreased in elderly women. Similarly, the chance of a female stroke patient being treated with thrombolysis was 13% lower than that of a male patient (odds ratioϭ0.867, 95% CIϭ0.782 to 0.960, Pϭ0.006). For patients admitted within the 3-hour time window, the chance of being treated with thrombolysis was similar for women and men (odds ratioϭ0.915, 95% CIϭ0.809 to 1.035, Pϭ0.156). Conclusions-We identified sex disparities in acute stroke management in terms of early hospital admission and thrombolytic treatment. This is best explained by the sociodemographic fact that "surviving spouses" are more likely to be women than men. Attempts to overcome disadvantages in their access to acute stroke care should focus on increased social support.

Differences in stroke outcome based on sex

“…25 Poststroke depression is more common in women than in men, 26 and this hinders functional recovery.…”

Sex Differences in Incidence, Mortality, and Survival in Individuals With Stroke in Scotland, 1986 to 2005

“…One possibility is that women are less likely than men to receive care on an acute stroke unit. 19 A number of studies have shown that women hospitalized after a stroke undergo fewer diagnostic procedures than men 15,20 and are less likely to receive thrombolytic treatment 20,21 ; however, these factors could not explain our findings. In addition, there is evidence of an increased admission threshold in women, especially elderly women.…”

Sex Differences in the Use of Intravenous rt-PA Thrombolysis Treatment for Acute Ischemic Stroke

“…Subsequent analysis identified a large German registry-based study as being influential because of its large size and the fact that it found no evidence of a sex disparity (ORϭ0.97). 11 After removing this study, the analysis of the remaining 3 studies resulted in a marginally significant OR of 0.67; the magnitude of this OR suggested that a substantial sex disparity remains after taking into account patient eligibility. Given the potential for differences in the administration of IV rt-PA between different health care delivery systems, we also conducted a subgroup analysis based on geographic location.…”