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Sex differences in quality of life after stroke were explained by patient factors, not clinical care: evidence from the Australian Stroke Clinical Registry

Citation

Phan, HT and Gall, SL and Blizzard, CL and Lannin, NA and Thrift, AG and Anderson, CS and Kim, J and Grimley, RS and Castley, HC and Kilkenny, MF and Cadilhac, DA, on behalf of the AuSCR Consortium and Stroke123 investigators, Sex differences in quality of life after stroke were explained by patient factors, not clinical care: evidence from the Australian Stroke Clinical Registry, European Journal of Neurology, 28, (2) pp. 469-478. ISSN 1351-5101 (2020) [Refereed Article]


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Copyright Statement

"This is the peer reviewed version of the following article: 'Sex differences in quality of life after stroke were explained by patient factors, not clinical care: evidence from the Australian Stroke Clinical Registry', which has been published in final form at doi 10.1111/ene.14531. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions."

DOI: doi:10.1111/ene.14531

Abstract

Background: Women may receive stroke care less often than men. We examined the contribution of clinical care on sex differences and health-related quality of life (HRQoL) after stroke.

Methods: We included first-ever strokes registered in the Australian Stroke Clinical Registry (2010-2014) with HRQoL assessed between 90-180 days after onset (EQ-5D-3L instrument) that were linked to hospital administrative data (up to 2013). Study factors included sociodemographics, comorbidities, walking ability on admission (stroke severity proxy) and clinical care (e.g. stroke unit care). Responses to the EQ-5D-3L were transformed into a total utility value (-0.516 'worse than death' to 1 'best' health). Quantile regression models, adjusted for confounding factors, were used to determine median differences (MD) in utility scores by sex.

Results: Approximately 60% (6,852/11,418) of stroke survivors had an EQ-5D-3L assessment (median 139 days; 44% female). Compared with men, women were older (median age 77.1 vs men 71.2) and fewer could walk on admission (37.9% vs men 46.1%, p<0.001). Women had lower utility values than men and the difference was explained by age and stroke severity, but not clinical care (MDadjusted -0.039, 95% CI -0.056, -0.021). Poorer HRQoL was observed in younger men (aged <65 years), particularly those with more comorbidities, and in older women (aged ≥75 years).

Conclusion: Stroke severity and co-morbidities contribute to the poorer HRQoL in young men and older women. Further studies are needed to understand age-sex interaction to better inform treatments for different sub-groups and ensure evidence-based treatments to reduce the severity of stroke are prioritized.

Item Details

Item Type:Refereed Article
Keywords:cerebrovascular diseases, cohort study, epidemiology, neurological disorders, quality of life, sex difference, stroke
Research Division:Health Sciences
Research Group:Epidemiology
Research Field:Epidemiology not elsewhere classified
Objective Division:Law, Politics and Community Services
Objective Group:Community services
Objective Field:Gender and sexualities
UTAS Author:Phan, HT (Dr Hoang Phan)
UTAS Author:Gall, SL (Associate Professor Seana Gall)
UTAS Author:Blizzard, CL (Professor Leigh Blizzard)
ID Code:140972
Year Published:2020
Web of Science® Times Cited:1
Deposited By:Menzies Institute for Medical Research
Deposited On:2020-09-16
Last Modified:2021-05-04
Downloads:0

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