Sex Differences in Quality of Life in Stroke Survivors

Gray, Laura J.; Sprigg, Nikola; Bath, Philip M.W.; Boysen, Gudrun; Deyn, Peter Paul De; Leys, Didier; O’Neill, Desmond; Ringelstein, E. B.

doi:10.1161/strokeaha.107.488304

Cited by 103 publications

(53 citation statements)

References 24 publications

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“…Contrary to predictions, and inconsistent with previous research in CD (15,19,21) and across a wide variety of health conditions (53,54), no gender differences in QOL were observed.…”

Section: Insert Table 2 Here Study 1 Discussioncontrasting

confidence: 99%

Reduced quality of life in coeliac disease is more strongly associated with depression than gastrointestinal symptoms

Sainsbury

Mullan

Sharpe

2013

Journal of Psychosomatic Research

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“…Contrary to predictions, and inconsistent with previous research in CD (15,19,21) and across a wide variety of health conditions (53,54), no gender differences in QOL were observed.…”

Section: Insert Table 2 Here Study 1 Discussioncontrasting

confidence: 99%

Reduced quality of life in coeliac disease is more strongly associated with depression than gastrointestinal symptoms

Sainsbury

Mullan

Sharpe

2013

Journal of Psychosomatic Research

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“…5,6,10,14 The timing and longitudinal assessment of QOL may be important, as sex differences may be greater early after stroke, then diminish over the long term with rehabilitation and recovery. 19 Whether there are truly differences in QOL for men and women independent of these factors is uncertain.…”

Section: Discussionmentioning

confidence: 99%

“…[2][3][4] Multiple studies, [5][6][7][8][9][10][11][12][13][14] but not all, [15][16][17][18] have shown that women have worse QOL after stroke than men, particularly in the domains of mental and physical function. 5,6,10,14 The timing and longitudinal assessment of QOL may be important, as sex differences may be greater early after stroke, then diminish over the long term with rehabilitation and recovery. 19 Whether there are truly differences in QOL for men and women independent of these factors is uncertain.…”

mentioning

confidence: 99%

Sex differences in quality of life after ischemic stroke

et al. 2014

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Objective: We aimed to compare quality of life (QOL) in women and men after ischemic stroke or TIA, and to determine the incremental impact of demographic, socioeconomic, clinical, and stroke-specific effects on longitudinal QOL. Methods:We assessed QOL in patients with ischemic stroke or TIA at 3 and 12 months postdischarge in the Adherence eValuation After Ischemic stroke-Longitudinal Registry using the European Quality of Life-5 Dimensions (EQ-5D) instrument. We generated multivariable linear regression models to evaluate the association between sex and EQ-5D while sequentially adjusting for sociodemographic, clinical, and stroke-related variables. We also used a proportional odds model to assess sex differences in the change in EQ-5D scores from 3 to 12 months.Results: A total of 1,370 patients were included, 53.7% male, median age 65 years (interquartile range 56-77 years). Women had significantly lower QOL at 3 months (unadjusted EQ-5D 0.81 in women vs 0.84 in men; p , 0.001) and 12 months (0.83 vs men 0.84; p , 0.001) poststroke. After multivariable adjustment for sociodemographic, clinical, and stroke-related factors, women continued to have lower QOL at 3 months (mean difference 20.036; p 5 0.003) and at 12 months (mean difference 20.022; p 5 0.046). Women fared worse in the dimensions of mobility, pain/ discomfort, and anxiety/depression at 3 and 12 months. There were no sex differences in change in EQ-5D score from 3 to 12 months. Conclusion:Women have worse QOL than men up to 12 months after stroke, even after adjusting for important sociodemographic variables, stroke severity, and disability. Neurology ® 2014;82:922-931 GLOSSARY ADL 5 activities of daily living; AVAIL 5 Adherence eValuation After Ischemic stroke-Longitudinal; CI 5 confidence interval; EQ-5D 5 European Quality of Life-5 Dimensions; GWTG-Stroke 5 Get With The Guidelines-Stroke; mRS 5 modified Rankin Scale; NIHSS 5 NIH Stroke Scale; OR 5 odds ratio; QOL 5 quality of life.Because stroke has dropped from the third to the fourth leading cause of death, 1 increasing attention should be given to improving quality of life (QOL) for stroke survivors. Several patient factors, including age, socioeconomic status, stroke severity, mood, and sex (particularly societal roles), may influence QOL after stroke.2-4 Multiple studies, 5-14 but not all, [15][16][17][18] have shown that women have worse QOL after stroke than men, particularly in the domains of mental and physical function. 5,6,10,14 The timing and longitudinal assessment of QOL may be important, as sex differences may be greater early after stroke, then diminish over the long term with rehabilitation and recovery. 19 Whether there are truly differences in QOL for men and women independent of these factors is uncertain.Our aims in this analysis were to (1) compare QOL in men and women at 3 and 12 months, (2) compare the change in QOL over time between men and women, and (3) determine the incremental impact of demographic, socioeconomic, clinical, and stroke-specific effects on long...

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“…[12][13][14][15][16][17][18] Two study cohorts that featured a slightly higher median baseline NIHSS (6 17 and 9.4 13 ) reported equipoise between the sexes in functional outcome when adjusting for age and stroke severity. Earlier work investigated sex difference in functional outcome measuring Stroke Impact Scale-16, 50 general dependency, 51 physical disability using modified Katz activities of daily living, 29 quality of life measures, 52 or the Barthel Index. 53 However, these measures may not be directly comparable to the mRS at day 90 or 180 after stroke.…”

Section: Sex-specific Natural Course As Measured By Mrs At Day 90mentioning

confidence: 99%

Sex and Stroke in Thrombolyzed Patients and Controls

Hametner¹,

MacIsaac²,

Kellert³

et al. 2017

Stroke

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Background and Purpose-We hypothesized that any sex-related difference in outcome poststroke is explained by other prognostic factors and that the response to intravenous recombinant tissue-type plasminogen activator (r-tPA) is equal in males and females after adjustment for such factors. Methods-We accessed an independent collection of randomized clinical trials-the VISTA (Virtual International Stroke Trials Archive). Data were preprocessed by selecting complete cases (n=8028) and matching females to males (coarsened exact matching, n=4575, 24.3% r-tPA). Outcome was assessed by the 7-point modified Rankin Scale (mRS) measured at 90 days after ischemic stroke. Relationship among variables was estimated by adjusted regression analysis. Results-In nonthrombolyzed patients, ordinal analysis of mRS adjusting for stroke-and sex-related prognostic factors suggested comparable outcomes for females and males (odds ratio, 0.96; 95% confidence interval, 0.85-1.06). Females responded comparably to r-tPA as did males, irrespective of the outcome definition of mRS (ordinal: P Interaction =0.46, relative excess risk because of interaction=0). The number needed to treat was 6.8 and 11.2 for 1 female to achieve mRS score of 0 to 2 and 0 to 1, which was highly congruent with males. Analysis for a nonlinear variation of ageby-sex revealed a good outcome for females <45 years with significant disadvantage thereafter (mRS score of 0-2: P Interaction =0.004). No relationship between sex, r-tPA, and bleeding complications was evident. Conclusions-Functional outcome (mRS) without r-tPA was overall similar between the sexes, as was the response to r-tPA.Nonlinear sex-by-age interaction improved estimates of functional independence; this should be considered in sex-related studies in stroke.

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Sex Differences in Quality of Life in Stroke Survivors

Cited by 103 publications

References 24 publications

Reduced quality of life in coeliac disease is more strongly associated with depression than gastrointestinal symptoms

Reduced quality of life in coeliac disease is more strongly associated with depression than gastrointestinal symptoms

Sex differences in quality of life after ischemic stroke

Sex and Stroke in Thrombolyzed Patients and Controls

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