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 © 2018 American Academy of Neurology
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 Type:||Refereed Article|
|Keywords:||stroke, functional outcome, sex difference|
|Research Division:||Health Sciences|
|Research Field:||Epidemiology not elsewhere classified|
|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)|
|Web of Science® Times Cited:||20|
|Deposited By:||Menzies Institute for Medical Research|
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