The confounding issue of sex and stroke

Stroke in women represents a substantial public health problem, a fact increasingly recognized across multiple disciplines.¹ Stroke affects more women than men because women live longer and stroke rates increase dramatically with age.² Women also suffer greater stroke-related disability and poorer quality of life than men after stroke³ for reasons that are not well understood.² Over the next few decades, the societal impact of stroke in women will increase as the population ages, underscoring the importance of obtaining a better understanding of the origins of and contributors to sex differences, so that potential interventions can be considered.

The degree to which sex differences in stroke management and outcome represent true health disparities requiring the attention of the clinical and public health communities remains uncertain. This is in part because there have been few studies on the topic, but also because the differences observed are to some extent explained by confounding factors such as age and prestroke comorbidities.⁴ The article by Gall and colleagues⁵ in this issue of Neurology® provides useful information to inform this debate. The report examines sex differences in clinical presentation, stroke severity, clinical care, and outcomes from 1,316 first-ever strokes in a population-based stroke registry from Melbourne, Australia. Many of …