Focused Update of Sex Differences in Patient Reported Outcome Measures After Stroke

Gall, Seana; Phan, Hoang; Madsen, Tracy E.; Reeves, Mathew J.; Rist, Pamela M.; Jiménez, Monik C.; Lichtman, Judith H.; Dong, Liming; Lisabeth, Lynda D.

doi:10.1161/strokeaha.117.018417

Cited by 69 publications

(94 citation statements)

References 70 publications

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“…Stroke is more frequent in the elderly: between 75 and 89% of strokes occur in patients over 65 years old [4,5]. In general, women experience worse outcomes after stroke and exhibit worse post-stroke functions than men [6,7]. Limited data is available about differences in sex relating to RF and stroke mortality by age group.…”

Section: Introductionmentioning

confidence: 99%

Age- and Sex-Specific Risk Profiles and In-Hospital Mortality in 13,932 Spanish Stroke Patients

Purroy¹,

Vena²,

Forné³

et al. 2019

Cerebrovasc Dis

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Background: In-hospital stroke death rate is an important sanitary issue. Despite advances in the acute phase management of stroke patients, mortality and disability rates remain high. In aging populations and with different mortality between the sexes in general, the study of sex- and age-related differences becomes increasingly relevant for optimization of post-acute clinical care of stroke patients. Methods: We designed a cohort follow-up study with 13,932 consecutive ischemic stroke (IS) patients from 19 Spanish hospitals. Data was obtained from the Spanish Stroke Registry; transient ischemic attacks and ages <18 years were excluded. Patients were organised by age group and sex. We compared female and male patient cohorts within and across age groups univariately and used multivariable logistic regression to adjust for confounders in differential in-hospital mortality. Results: The median (percentiles 2.5 and 97.5%) age was 78 (41–92) years old for women and 71 (41–92) for men. IS women were more likely to be older, to exhibit cardio-embolic aetiology, and less likely to have been admitted to a stroke unit or to have had a stroke code activated. Both pre-stroke modified Rankin Scale and National Institute of Health Stroke Scale (NIHSS) scores at admission increased significantly with age and were higher in women than those in men. Differences in distributions of common risk factors for IS and of in-hospital outcomes between women and men actually changed with patient’s age. It is to be noted here that although there were no statistically significant differences (p > 0.05) between the sexes within any age group, in-hospital mortality appeared significantly higher in women than that in men when analysed overall, due to confounding. Death was more closely related to stroke in women than in men and occurred earlier. Although there were some age-specific sex differences between the predictors for in-hospital mortality, stroke severity measured by NIHSS was the main predictor of in-hospital mortality for both sexes. Topographic classifications – partial anterior circulatory infarct and total anterior circulatory infarct – were significant prognostic factors for men aged <60 years and for those in the 60–69 years range respectively. Conclusion: Although most of our findings were consistent with previous studies, it is important to take into account and highlight differences in in-hospital mortality between the sex and age group. Not to account for age-related differences between the sexes can give false results that may mislead management decisions. As most deaths in women were related to stroke, it is important to improve their early management, stroke code activation, access to stroke units and/or revascularisation therapies, especially in the older age groups.

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Section: Introductionmentioning

confidence: 99%

Age- and Sex-Specific Risk Profiles and In-Hospital Mortality in 13,932 Spanish Stroke Patients

Purroy¹,

Vena²,

Forné³

et al. 2019

Cerebrovasc Dis

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“…The sex differences reported in this study concur with existing literature which found females experiencing worse outcomes compared to males. This is not unique to knee surgery, as similar observations have been made in patients with stroke [32,33], rheumatoid arthritis [34] and in bipolar disorders [35]. The specific reasons for this are unclear but pain can have substantial impact on patient's QoL outcomes and women with osteoarthritis may experience more pain and greater pain sensitivity which can translate into poorer QoL [36,37].…”

Section: Discussionmentioning

confidence: 81%

Co-Morbidities and Sex Differences in Long-Term Quality-of-Life Outcomes among Patients with and without Diabetes after Total Knee Replacement: Five-Year Data from Registry Study

Tew

Dowsey

Choong

et al. 2019

JCM

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“…Gall et al 21 show that women have poorer outcomes, including worse health-related quality of life with more activity limitations, as well as more poststroke depression. However, many of these associations are attenuated with adjustment for age at presentation, stroke severity, and comorbid conditions.…”

Section: Strokementioning

confidence: 99%

“…In this edition of Stroke, the papers by McDermott et al, 7 Demel et al, 13 Madsen et al, 17 and Gall et al 21 argue for further recognition of the factors causing stroke in women and for systematic intensification of treatments. Sex differences in stroke burden are most influenced by differences in cardiovascular risk factor burden; thus, the greatest gains in stroke prevention will come from increased screening and treatment of these primary risk factors in women early in life, especially in the obese, during pregnancy, and those from high-risk ethnoracial groups.…”

Section: Strokementioning

confidence: 99%

Stroke in Women

Kaplovitch

Anand

2018

Stroke

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Progress continues, however, with both women-exclusive randomized control trials 3 and observational prospective studies currently being conducted. 4 The information generated from this research has increased our understanding of the determinants of and medical therapies to prevent stroke in women, yet some questions remain, and ongoing surveillance of stroke incidence and outcomes after stroke is required.In high-income countries, like the United States, women have a greater lifetime risk of stroke than men. Further, stroke rates differ by ethnoracial origin with a higher stroke rate occurring in Black and Hispanic women living in the United States. The major risk factors for stroke and the strength of association of the risk factors are similar in women and men, with preeclampsia, pregnancy, and use of exogenous hormones as the few exceptions. However, the frequency of each risk factor, and therefore the population attributable risk, differs between the sexes. As shown in the international INTERSTROKE case-control study, 5 hypertension, abdominal obesity, and adverse lipid profile are the most impactful causes of stroke in women worldwide, with smoking, cardiac causes, and lifestyle factors (ie, diet quality, exercise, alcohol use) remaining as important, but not as frequent, risk factors. It is through screening and treatment of these common risk factors where the greatest gains in stroke prevention can occur. After a stroke occurs, ensuring equal access to health care and evidence-based stroke management will equalize stroke outcomes by sex. Although progress has been made, with the first guideline specifically targeted to stroke in women recently published, 6 implementation of the optimal screening and treatment for women at risk for stroke is urgently needed.In today's edition of Stroke, a series of 4 articles present aspects of stroke physiology and epidemiology unique to women: the vascular biology of preeclampsia and its relationship to stroke; hormonal risk factors for stroke in women; an update on classical stroke risk factors in women; and sex/gender differences in stroke outcomes. Underscoring all of these sex-and gender-specific differences is a call for more intensive risk factor modification throughout the entirety of a woman's life course.Pregnancy is often the first major stroke risk factor experienced by young women. As McDermott et al 7 attest, stroke affects ≈30 women for every 100 000 pregnancies. Although hormonal factors, peripartum illness, and hemodynamic factors play a role, the majority of events are mediated through the spectrum of hypertensive disorders in pregnancy, particularly preeclampsia/toxemia. A systemic, multiorgan endotheliopathy, preeclampsia both predisposes to the malignant edema in posterior reversible encephalopathy syndromes and confers a 40-fold risk increase for true ischemic stroke. The most important prevention strategy is early detection, which should be emphasized with frequent antenatal blood pressure measurements and screening for signs and symptoms of toxemi...

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Focused Update of Sex Differences in Patient Reported Outcome Measures After Stroke

Cited by 69 publications

References 70 publications

Age- and Sex-Specific Risk Profiles and In-Hospital Mortality in 13,932 Spanish Stroke Patients

Age- and Sex-Specific Risk Profiles and In-Hospital Mortality in 13,932 Spanish Stroke Patients

Co-Morbidities and Sex Differences in Long-Term Quality-of-Life Outcomes among Patients with and without Diabetes after Total Knee Replacement: Five-Year Data from Registry Study

Stroke in Women

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