Phan, HT and Reeves, MJ and Blizzard, CL and Thrift, AG and Cadilhac, DA and Sturm, J and Otahal, P and Rothwell, P and Bejot, Y and Cabral, NL and Appelros, P and Korv, J and Vibo, R and Minelli, C and Gall, SL, Sex differences in severity of stroke in the INSTRUCT Study: a meta-analysis of individual participant data, Journal of the American Heart Association, 8, (1) Article e010235. ISSN 2047-9980 (2019) [Refereed Article]
Methods and Results: We pooled individual participant data with National Institutes of Health Stroke Scale assessment (N=6343) from 8 population-based stroke incidence studies (1996-2014), forming part of INSTRUCT (International Stroke Outcomes Study). Information on sociodemographics, stroke-related clinical factors, comorbidities, and pre-stroke function were obtained. Within each study, relative risk regression using log-binominal modeling was used to estimate the female:male relative risk ( RR ) of more severe stroke (National Institutes of Health Stroke Scale>7) stratified by stroke type (ischemic stroke and intracerebral hemorrhage). Study-specific unadjusted and adjusted RR s, controlling for confounding variables, were pooled using random-effects meta-analysis. National Institutes of Health Stroke Scale data were recorded in 5326 (96%) of 5570 cases with ischemic stroke and 773 (90%) of 855 participants with intracerebral hemorrhage. The pooled unadjusted female:male RR for severe ischemic stroke was 1.35 (95% CI 1.24-1.46). The sex difference in severity was attenuated after adjustment for age, pre-stroke dependency, and atrial fibrillation but remained statistically significant (pooled RRadjusted 1.20, 95% CI 1.10-1.30). There was no sex difference in severity for intracerebral hemorrhage ( RRcrude 1.08, 95% CI 0.97-1.21; RRadjusted 1.08, 95% CI 0.96-1.20).
Conclusions: Although women presented with more severe ischemic stroke than men, much although not all of the difference was explained by pre-stroke factors. Sex differences could potentially be ameliorated by strategies to improve pre-stroke health in the elderly, the majority of whom are women. Further research on the potential biological origin of sex differences in stroke severity may also be warranted.
|Item Type:||Refereed Article|
|Keywords:||stroke, sex differences, severity of stroke|
|Research Division:||Medical and Health Sciences|
|Research Group:||Public Health and Health Services|
|Objective Group:||Public Health (excl. Specific Population Health)|
|Objective Field:||Public Health (excl. Specific Population Health) not elsewhere classified|
|UTAS Author:||Phan, HT (Miss Hoang Phan)|
|UTAS Author:||Blizzard, CL (Professor Leigh Blizzard)|
|UTAS Author:||Otahal, P (Mr Petr Otahal)|
|UTAS Author:||Gall, SL (Associate Professor Seana Gall)|
|Deposited By:||Menzies Institute for Medical Research|
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