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Factors contributing to sex differences in functional outcomes and participation after stroke


Phan, HT and Blizzard, CL and Reeves, MJ and Thrift, AG and Cadilhac, DAC and Sturm, J and Heeley, E and Otahal, P and Vemmos, K and Anderson, C and Parmar, P and Krishnamurthi, R and Barker-Collo, S and Feigin, V and Bejot, Y and Cabral, NL and Carolei, A and Sacco, S and Chausson, N and Olindo, S and Rothwell, P and Silva, C and Correia, M and Magalhaes, R and Appelros, P and Korv, J and Vibo, R and Minelli, C and Gall, SL, Factors contributing to sex differences in functional outcomes and participation after stroke, Neurology, 90, (22) pp. e1945-e1953. ISSN 0028-3878 (2018) [Refereed Article]

Copyright Statement

Copyright 2018 American Academy of Neurology

DOI: doi:10.1212/WNL.0000000000005602


Objective: To examine factors contributing to the sex differences in functional outcomes and participation restriction after stroke.

Methods: Individual participant data on long-term functional outcome or participation restriction (i.e., handicap) were obtained from 11 stroke incidence studies (1993-2014). Multivariable log-binomial regression was used to estimate the female:male relative risk (RR) of poor functional outcome (modified Rankin Scale score >2 or Barthel Index score <20) at 1 year (10 studies, n = 4,852) and 5 years (7 studies, n = 2,226). Multivariable linear regression was used to compare the mean difference (MD) in participation restriction by use of the London Handicap Scale (range 0-100 with lower scores indicating poorer outcome) for women compared to men at 5 years (2 studies, n = 617). For each outcome, study-specific estimates adjusted for confounding factors (e.g., sociodemographics, stroke-related factors) were combined with the use of random-effects meta-analysis.

Results: In unadjusted analyses, women experienced worse functional outcomes after stroke than men (1 year: pooled RRunadjusted 1.32, 95% confidence interval [CI] 1.18-1.48; 5 years: RRunadjusted 1.31, 95% CI 1.16-1.47). However, this difference was greatly attenuated after adjustment for age, prestroke dependency, and stroke severity (1 year: RRadjusted 1.08, 95% CI 0.97-1.20; 5 years: RRadjusted 1.05, 95% CI 0.94-1.18). Women also had greater participation restriction than men (pooled MDunadjusted -5.55, 95% CI -8.47 to -2.63), but this difference was again attenuated after adjustment for the aforementioned factors (MDadjusted -2.48, 95% CI -4.99 to 0.03).

Conclusions: Worse outcomes after stroke among women were explained mostly by age, stroke severity, and prestroke dependency, suggesting these potential targets to improve the outcomes after stroke in women.

Item Details

Item Type:Refereed Article
Keywords:stroke, functional outcome, sex difference
Research Division:Health Sciences
Research Group:Epidemiology
Research Field:Epidemiology not elsewhere classified
Objective Division:Health
Objective Group:Clinical health
Objective Field:Clinical health not elsewhere classified
UTAS Author:Phan, HT (Dr Hoang Phan)
UTAS Author:Blizzard, CL (Professor Leigh Blizzard)
UTAS Author:Otahal, P (Mr Petr Otahal)
UTAS Author:Gall, SL (Associate Professor Seana Gall)
ID Code:128390
Year Published:2018
Web of Science® Times Cited:37
Deposited By:Menzies Institute for Medical Research
Deposited On:2018-09-18
Last Modified:2019-03-04

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