Gender differences in characteristics, management and outcome at discharge and three months after stroke in a national acute stroke registry

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Abstract

Background

The importance of gender as an independent risk factor for poor outcome is not clear. We examined gender differences in patients' characteristic, management and outcome at discharge and 3-months after acute stroke in a national hospital-based registry.

Methods

Data were derived from the triennial two-month national Acute Stroke Israeli Registry (Feb–March 2004, March–April 2007, April–May 2010). Unselected patients in all Israeli hospitals (n = 28) were included. Outcome at 3-month was assessed in a sub-sample. Logistic regression models were used in the study of gender as an independent risk factor for poor outcome.

Results

In total, 5034 patients (88.5% ischemic stroke, 9.6% ICH and 1.9% undetermined stroke) were included, of them 2285 (45.4%) women. Follow-up at 3-month was completed for 1040 patients, 41.9% women. Women showed higher rates of cardiovascular risk factors in-hospital death (p = 0.007) and poor functional outcome (p < 0.0001). Following adjustment for age, prior disability, NIHSS, prior stroke and risk factors, risk estimates (ORs, 95%CI) for women compared to men were 0.72 (0.55–0.96) for in-hospital death, 1.03 (0.83–1.29) for discharge to a nursing home or death, and 1.01 (0.86–1.20) for disability. Poor outcomes at 3-month were significantly more common in women; however, adjusted risk estimates were not significantly increased: OR 0.95 (95%CI 0.50–1.81) for death at 3-months, 1.41 (0.99–2.01) for Barthel Index  60, 1.24 (0.90–1.72) for dependency and 0.88 (0.55–1.39) for living in a nursing home or death.

Conclusion

Gender-differences in risk of death and poor functional outcome after stroke are mainly explained by dissimilarities in patients' characteristics and stroke severity.

Introduction

Age-specific incidence rates of stroke are higher for men than women. However, longer life expectancy for women and the steep increase in stroke rates in older ages result in greater numbers of women affected by stroke [1], [2]. In addition, studies have reported higher rates of 1-month death [3], poorer functional outcome [4], [5], [6] and higher rates of handicap [6], [7], [8], [9] in women compared to men. Although studies generally provide evidence for poorer outcome in women, a recent review has reported findings of several studies according to which men have poorer outcomes and numerous studies with similar outcomes for men and women [10]. Since there are gender differences in the characteristics of patients, adjusting for potential confounding effects is crucial for the understanding of the effect of gender on short and long term poor outcome after stroke. We examined gender differences in patients' characteristics on admission, management and functional outcome at discharge and 3-months after stroke in acute stroke patients in a national hospital-based stroke registry.

Section snippets

Study setting

The prospective hospital-based National Acute Stroke Israeli (NASIS) registry is performed during 2-month periods triennially. All consecutive patients hospitalized due to acute stroke or transient ischemic attack, in all hospitals in Israel (n = 28) during the study periods, are included in this ongoing registry. The NASIS registry was approved by the ethical committees of the participating medical centers, permitting waivers of informed consent for this nationwide observational study. Details

Baseline characteristics and management

All acute stroke patients in the NASIS project 2004, 2007 and 2010 were included (n = 5034, 54.6% men and 45.4% women). Women were on average 4.5 years older than men. Prevalence of hypertension (p < 0.0001), atrial fibrillation (p < 0.0001), and prior disability (p < 0.0001) were significantly higher and stroke was more severe in women than men, while current smoking (p < 0.0001), dyslipidemia (p < 0.0001), peripheral artery disease (p = 0.001) and prior heart disease (p = 0.007) were significantly more common

Discussion

Women with stroke were older and presented with a different profile of risk factors than men in our unselected national sample of hospitalized patients with acute stroke. Specifically, hypertension, atrial fibrillation and prior disability were significantly more common in women, while dyslipidemia, prior heart disease, peripheral artery disease and current smoking were more prevalent in men. Disability prior to stroke was more common and stroke was more severe in women than in men. We also

Conclusions

Women exhibit higher rates of mortality and poor functional outcome at discharge and 3-months after stroke. However, gender-differences in risks of death, disability and dependency after stroke are mainly explained by dissimilarities between men and women in age, risk factors, functional status prior to stroke and stroke severity.

Acknowledgments

The National Acute Stroke Israeli project is supported by the Israeli Center for Disease Control, Israeli Ministry of Health and by MSD, Novo-Nordisk, Pfizer, Sanofi-Aventis, Rafa Laboratories and Teva.

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