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Abstract
Objective To explore the sex differences in outcomes and management after stroke using a large sample with high-quality international trial data.
Methods Individual participant data were obtained from 5 acute stroke randomized controlled trials. Data were obtained on demographics, medication use, in-hospital treatment, and functional outcome. Study-specific crude and adjusted models were used to estimate sex differences in outcomes and management, and then pooled using random-effects meta-analysis.
Results There were 19,652 participants, of whom 7,721 (40%) were women. After multivariable adjustments, women with ischemic stroke had higher survival at 3–6 months (odds ratio [OR] 0.82, 95% confidence interval [CI] 0.70–0.97), higher likelihood of disability (OR 1.20, 95% CI 1.06–1.36), and worse quality of life (weighted mean difference −0.07, 95% CI −0.09 to 0.04). For management, women were more likely to be admitted to an acute stroke unit (OR 1.17, 95% CI 1.01–1.34), but less likely to be intubated (OR 0.58, 95% CI 0.36–0.93), treated for fever (OR 0.82, 95% CI 0.70–0.95), or admitted to an intensive care unit (OR 0.83, 95% CI 0.74–0.93). For preadmission medications, women had higher odds of being prescribed antihypertensive agents (OR 1.22, 95% CI 1.13–1.31) and lower odds of being prescribed antiplatelets (OR 0.86, 95% CI 0.79–0.93), glucose-lowering agents (OR 0.86, 95% CI 0.78–0.94), or lipid-lowering agents (OR 0.85, 95% CI 0.77–0.94).
Conclusions This analysis suggests that women who had ischemic stroke had better survival but were also more disabled and had poorer quality of life. Variations in hospital and out-of-hospital management may partly explain the disparities.
Glossary
- AF=
- atrial fibrillation;
- ASU=
- acute stroke unit;
- BP=
- blood pressure;
- CI=
- confidence interval;
- CV=
- cardiovascular;
- ENCHANTED=
- Enhanced Control of Hypertension and Thrombolysis Stroke study;
- HeadPoST=
- Head Position in Acute Stroke Trial;
- HRQoL=
- health-related quality of life;
- ICH=
- intracerebral hemorrhage;
- ICU=
- intensive care unit;
- INTERACT=
- Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial;
- IPD=
- individual participant data;
- mRS=
- modified Rankin Scale;
- NIHSS=
- NIH Stroke Scale;
- OR=
- odds ratio;
- SCAST=
- Scandinavian Candesartan Acute Stroke Trial;
- SSS=
- Scandinavian Stroke Scale
Footnotes
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
↵* These authors contributed equally to this work as co–first authors.
Editorial, page 1025
- Received January 30, 2019.
- Accepted in final form July 29, 2019.
- © 2019 American Academy of Neurology
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Editors' note: Sex differences in treatment and outcome after stroke: Pooled analysis including 19,000 participants
Sex differences in the use of therapeutic resources and stroke outcomes in 5 randomized trials