Sex differences in profile and in-hospital mortality for acute stroke in Chile: data from a nationwide hospital registry

Abstract

BackgroundKnowledge of local contextual sex-differences in the profile and outcome for stroke can improve service delivery. We aimed to determine sex-differences in the profile of patients with acute stroke and their associations with in-hospital mortality (I-HM) in the national hospital database of Chile.MethodsWe present a retrospective cohort based on the analysis of the 2019 Chilean database of Diagnosis-Related Groups (DRGs), which represents 70% of the operational expenditure of the public health system. Multiple logistic regression models were used to determine independent associations of acute stroke (defined by main diagnosis ICD-10 codes) and I-HM, and reported with odds ratios (OR) and 95% confidence intervals (CI).ResultsOf 1,048,575 hospital discharges, 15,535 were for patients with acute stroke (7,074 [45.5%] in women) and 2,438 (15.6%) of them died in-hospital. Disparities by sex in sociodemographic and clinical characteristics were identified for stroke and main subtypes. Women with ischemic stroke had lower I-HM (OR 0.80, 95%CI 0.70-0.92;P=0.002) compared to men; other independent predictors included age (1.03, 1.03-1.04;P<0.001), chronic kidney disease (CKD) (1.48, 1.20-1.81;P<0.001), atrial fibrillation (1.56, 1.34-1.83;P<0.001), admission to hospital without a stroke unit (1.21, 1.05-1.39;P=0.003), and several risk factors. Conversely for intracerebral hemorrhage, women had higher I-HM than men (1.21, 1.04-1.41; P=0.02); other independent predictors included age (1.01, 1.00-1.01;P<0.001), CKD (1.54, 1.22-1.94;P<0.001), oral anticoagulant use (2.01, 1.56-2.59;P<0.001), and several risk factors.ConclusionSex disparities in patients characteristics and in-hospital mortality exist for acute stroke in Chile. I-HM is higher for acute ischemic stroke in men and higher for ICH in women. Future research is need to better identify contributing factors.