Sex Differences in Long-Term Quality of Life Among Survivors After Stroke in the INSTRUCT

Abstract

Background and Purpose— Women are reported to have poorer health-related quality of life (HRQoL) after stroke than men, but the underlying reasons are uncertain. We investigated factors contributing to the sex differences. Methods— Individual participant data on 4288 first-ever strokes (1996–2013) were obtained from 4 high-quality population-based incidence studies from Australasia and Europe. HRQoL utility scores among survivors after stroke (range from negative scores=worse than death to 1=perfect health) were calculated from 3 scales including European Quality of Life-5 Dimensions, Short-Form 6-Dimension, and Assessment of Quality of Life at 1 year (3 studies; n=1210) and 5 years (3 studies; n=1057). Quantile regression was used to estimate the median differences in HRQoL for women compared to men with adjustment for covariates. Study factors included sociodemographics, prestroke dependency, stroke-related factors (eg, stroke severity), comorbidities, and poststroke depression. Study-specific median differences were combined into pooled estimates using random-effect meta-analysis. Results— Women had lower pooled HRQoL than men (median difference unadjusted 1 year, −0.147; 95% CI, −0.258 to −0.036; 5 years, −0.090; 95% CI, −0.119 to −0.062). After adjustment for age, stroke severity, prestroke dependency, and depression, these pooled median differences were attenuated, more greatly at 1 year (−0.067; 95% CI, −0.111 to −0.022) than at 5 years (−0.085; 95% CI, −0.135 to −0.034). Conclusions— Women consistently exhibited poorer HRQoL after stroke than men. This was partly attributable to women’s advanced age, more severe strokes, prestroke dependency, and poststroke depression, suggesting targets to reduce the differences. There was some evidence of residual differences in HRQoL between sexes but they were small and unlikely to be clinically significant.

Sex differences in risk factors, treatment, and prognosis in acute stroke

“…Furthermore, long-term functional stroke outcome seemed to be worse in women. Our results are partly in agreement with several earlier reports [24][25][26] ; however, in the present study, female sex alone seemed to be an independent risk factor for worse functional outcome, post-stroke depression, and fatigue, contradictory to previous reports. [27][28][29] Case fatality after 27 days and after 90 days was the same in men and women, after adjustment for the aforementioned covariates.…”

Parameters Affecting Stroke Severity and Outcome in Acute Stroke Patients Treated With Iv Thrombolysis

“…In accordance with the results of our study, in literature it was proven that the prevalence of stroke in females is lower than males, and several studies have shown that females suffered from more severe strokes, had higher short-term mortality than males, but long-term sex differences in mortality persist up to 5 years after stroke (10,11,12). Ghosh et al also reported that female patients had significantly higher incidence of poor outcome, but female gender was not a significant predictor of stroke severity and mortality (6).…”

“…Ghosh et al also reported that female patients had significantly higher incidence of poor outcome, but female gender was not a significant predictor of stroke severity and mortality (6). Additionally, in other studies, parameters of worse functional outcome at 1-and 5-year follow-up, greater mental impairment, and lower quality of life were determined in females compared to males (10,13).…”

Sex and gender: modifiers of health, disease, and medicine

“…This difference is due to the older age of first stroke in women, the higher pre-existing disability in elderly women, the larger strokes seen in women (many from atrial fibrillation), and social factors such as post-stroke depression and social isolation experienced by elderly women. 98 , 99 …”