Sex differences in treatment and outcome after stroke Pooled analysis including 19,000 participants
Journal
Neurology
ISSN
0028-3878
1526-632X
Date Issued
2019
Author(s)
Cheryl Carcel
Xia Wang
Else Charlotte Sandset
Candice Delcourt
Hisatomi Arima
Richard Lindley
Maree L. Hackett
Thompson G. Robinson
Eivind Berge
John Chalmers
Mark Woodward
Craig S. Anderson
Type
Resource Types::text::journal::journal article
URL Institutional Repository
Abstract
<jats:sec><jats:title>Objective</jats:title><jats:p>To explore the sex differences in outcomes and management after stroke using a large sample with high-quality international trial data.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>Individual 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.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>There 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).</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>This 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.</jats:p></jats:sec>
Cite this document
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). https://doi.org/10.1212/WNL.0000000000008615
Subjects
adult
;
aged
;
aged, 80 and over
;
female
;
humans
;
male
;
middle aged
;
sex factors
;
stroke
;
treatment outcome
;
alteplase
;
candesartan
;
placebo
;
adult
;
article
;
brain hemorrhage
;
brain ischemia
;
controlled study
;
crossover procedure
;
demography
;
disability
;
double blind procedure
;
drug use
;
female
;
fever
;
hospital admission
;
human
;
intensive care unit
;
intubation
;
major clinical study
;
male
;
middle aged
;
multicenter study
;
open study
;
prescription
;
priority journal
;
prospective study
;
quality of life
;
randomized controlled trial
;
sex difference
;
survival
;
treatment outcome
;
aged
;
cerebrovascular accident
;
complication
;
mortality
;
sex factor
;
very elderly