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Sex differences in care and long-term mortality after stroke: Australian Stroke Clinical Registry


Phan, HT and Gall, SL and Blizzard, CL and Lannin, NA and Thrift, AG and Anderson, CS and Kim, J and Grimley, R and Castley, HC and Hand, P and Cadilhac, DA, on behalf of the AuSCR Consortium, Sex differences in care and long-term mortality after stroke: Australian Stroke Clinical Registry, Journal of Women's Health, 28, (5) pp. 712-720. ISSN 1540-9996 (2019) [Refereed Article]

Copyright Statement

Copyright 2019 Mary Ann Liebert, Inc.

DOI: doi:10.1089/jwh.2018.7171


Introduction: There is some evidence that women receive evidence-based care less often than men, but how this influences long-term mortality after stroke is unclear. We explored this issue using data from a national stroke registry.

Materials and Methods: Data are first-ever hospitalized strokes (2010-2014) in the Australian Stroke Clinical Registry from 39 hospitals linked to the national death registrations. Multilevel Poisson regression was used to estimate the women:men mortality rate ratio (MRR), with adjustment for sociodemographics, stroke severity, and processes of care (stroke unit care, intravenous thrombolysis, antihypertensive agent[s], and discharge care plan).

Results: Among 14,118 events (46% females), women were 7 years older and had greater baseline severity compared to men (29% vs. 37%; p < 0.001), but there were no differences in the four processes of care available across hospitals. In the whole cohort, 1-year mortality was greater in women than men (MRRunadjusted 1.44, 95% confidence interval [CI] 1.34-1.54). However, there were no differences after adjusting for age and stroke severity (MRRadjusted 1.03, 95% CI 0.95-1.10). In analyses of additional processes from Queensland hospitals (n = 5224), women were less often administered aspirin ≤48 hours (61% vs. men 69%, p < 0.015). In Queensland hospitals, there were no statistically significant sex differences in 1-year mortality after adjusting for age, stroke severity, and early administration of aspirin.

Conclusion: Greater mortality in women can be explained by differences in age and stroke severity. This highlights the importance of better management of risk factors in the elderly and, potentially, the need for greater access to early aspirin for women with stroke.

Item Details

Item Type:Refereed Article
Keywords:quality of care, mortality, sex difference, stroke
Research Division:Biomedical and Clinical Sciences
Research Group:Cardiovascular medicine and haematology
Research Field:Cardiology (incl. cardiovascular diseases)
Objective Division:Health
Objective Group:Specific population health (excl. Indigenous health)
Objective Field:Women's and maternal health
UTAS Author:Phan, HT (Dr Hoang Phan)
UTAS Author:Gall, SL (Associate Professor Seana Gall)
UTAS Author:Blizzard, CL (Professor Leigh Blizzard)
ID Code:133149
Year Published:2019
Web of Science® Times Cited:16
Deposited By:Menzies Institute for Medical Research
Deposited On:2019-06-13
Last Modified:2020-08-14

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