Sex differences in treatment and outcome after stroke: Pooled analysis including 19,000 participants

Cheryl Carcel, Xia Wang, Else Charlotte Sandset, Candice Delcourt, Hisatomi Arima, Richard Lindley, Maree L. Hackett, Pablo Lavados, Thompson G. Robinson, Paula Muñoz Venturelli, Verónica V. Olavarría, Alejandro Brunser, Eivind Berge, John Chalmers, Mark Woodward, Craig S. Anderson

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

ObjectiveTo explore the sex differences in outcomes and management after stroke using a large sample with high-quality international trial data.MethodsIndividual participant data were obtained from 5 acute stroke randomized controlled trials. Data were obtained on demographics, medication use, in-hospital treatment, and functional outcome. Study-specific crude and adjusted models were used to estimate sex differences in outcomes and management, and then pooled using random-effects meta-analysis.ResultsThere were 19,652 participants, of whom 7,721 (40%) were women. After multivariable adjustments, women with ischemic stroke had higher survival at 3-6 months (odds ratio [OR] 0.82, 95% confidence interval [CI] 0.70-0.97), higher likelihood of disability (OR 1.20, 95% CI 1.06-1.36), and worse quality of life (weighted mean difference -0.07, 95% CI -0.09 to 0.04). For management, women were more likely to be admitted to an acute stroke unit (OR 1.17, 95% CI 1.01-1.34), but less likely to be intubated (OR 0.58, 95% CI 0.36-0.93), treated for fever (OR 0.82, 95% CI 0.70-0.95), or admitted to an intensive care unit (OR 0.83, 95% CI 0.74-0.93). For preadmission medications, women had higher odds of being prescribed antihypertensive agents (OR 1.22, 95% CI 1.13-1.31) and lower odds of being prescribed antiplatelets (OR 0.86, 95% CI 0.79-0.93), glucose-lowering agents (OR 0.86, 95% CI 0.78-0.94), or lipid-lowering agents (OR 0.85, 95% CI 0.77-0.94).ConclusionsThis analysis suggests that women who had ischemic stroke had better survival but were also more disabled and had poorer quality of life. Variations in hospital and out-of-hospital management may partly explain the disparities.

Original languageEnglish
Pages (from-to)E2170-E2180
Number of pages13
JournalNeurology
Volume93
Issue number24
DOIs
Publication statusPublished - 10 Dec 2019
Externally publishedYes

Keywords

  • all clinical trials
  • All Cerebrovascular disease/Stroke
  • access to care
  • quality of life

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    Carcel, C., Wang, X., Sandset, E. C., Delcourt, C., Arima, H., Lindley, R., Hackett, M. L., Lavados, P., Robinson, T. G., Muñoz Venturelli, P., Olavarría, V. V., Brunser, A., Berge, E., Chalmers, J., Woodward, M., & Anderson, C. S. (2019). Sex differences in treatment and outcome after stroke: Pooled analysis including 19,000 participants. Neurology, 93(24), E2170-E2180. https://doi.org/10.1212/WNL.0000000000008615