Women have a poorer very long-term functional outcome after stroke among adults aged 18–50 years: the FUTURE study

Abstract

Due to their young age young stroke survivors have to cope with a dramatic impact on their life for the decades to come. We investigated the sex-specific very long-term functional outcome after transient ischemic attack (TIA) and ischemic stroke (IS) in adults aged 18–50 years. This study is part of a cohort study among 619 first-ever young ischemic stroke patients, admitted to our department between January 1, 1980 and November 1, 2010. Functional outcome was assessed during follow-up in 2009–2011 and in 2014–2015 with the modified Rankin Scale (mRS) and instrumental Activities of Daily Living scale (iADL). Risk factors for a poor functional outcome (mRS > 2 and iADL < 8) were calculated by logistic regression analysis. After a mean follow-up of 13.9 (SD 8.2) years, 24.5 % of TIA patients and 44.7 % of IS patients had a poor functional outcome (mRS > 2). When assessing the survivors, 15.2 % of TIA patients and 22.9 % of IS patients had a poor outcome as assessed by iADL. The strongest baseline predictors of poor outcome were female sex (OR 2.7, 95 % CI 1.5–5.0) and baseline NIHSS (OR 1.1, 95 % CI 1.1–1.2 per point increase). In conclusion, 14 years after an ischemic cerebrovascular event in young adults, one out of five IS survivors and one out of ten TIA survivors is still dependent in daily life, with a two to threefold higher risk of a poor outcome in women. This includes a period of life, during which important decisions regarding work and family life have to be made.

Low self-reported sports activity before stroke predicts poor one-year-functional outcome after first-ever ischemic stroke in a population-based stroke register

“…In line with other studies, female sex proved to be an independent predictor for lack of functional independence [ 7 , 62 ]. Gall et al hypothesized that females are more vulnerable than men because of differences in chronic diseases, socioeconomic status and medical histories [ 63 ].…”

“…Gall et al hypothesized that females are more vulnerable than men because of differences in chronic diseases, socioeconomic status and medical histories [ 63 ]. Females are more likely to suffer from severe strokes [ 62 , 64 ]. A further reason might be the sex-related differences in muscular strength, or different approaches to handle their disabilities.…”

Heart Disease and Stroke Statistics—2017 Update: A Report From the American Heart Association

“…The strongest baseline predictors of poor outcome were female sex (OR, 2.7; 95% CI, 1.5–5.0) and baseline NIHSS (OR, 1.1, 95% CI, 1.1–1.2 per point increase). 290 …”

Stroke in women — from evidence to inequalities

“…Consequently, women are more likely to be discharged with more severe neurological deficits than men. In a Dutch study of young patients with ischaemic stroke (aged 18-50 years), women had a twofold to threefold higher risk of a poor functional outcome than men during 13 years of follow up 99 .…”