Sex differences in presentation, severity, and management of stroke in a population-based study
Gall, SL and Donnan, G and Dewey, HM and Macdonell, R and Sturm, J and Gilligan, A and Srikanth, V and Thrift, AG, Sex differences in presentation, severity, and management of stroke in a population-based study, Neurology, 74, (12) pp. 975-981. ISSN 0028-3878 (2010) [Refereed Article]
Objectives: Women may have poorer outcomes after stroke than men because of differences in
their acute management. We examined sex differences in presentation, severity, in-hospital treatment,
and early mortality in a cohort of first-ever-in-a-lifetime stroke patients.
Methods: Data were collected from May 1, 1996, to April 30, 1999, in the North East Melbourne
Stroke Incidence Study. Stroke symptoms, prestroke medical history, in-hospital investigations,
admission and discharge medications, initial stroke severity, and 28-day mortality were recorded.
Multivariable regression was used to estimate sex differences in treatment, investigations, and
Results: A total of 1,316 patients were included. Women were older (mean age 76 0.6 vs 72
0.6, p 0.01), had more severe strokes (median NIH Stroke Scale score 6 vs 5, p 0.01), and
more likely to experience loss of consciousness (31% vs 23%, p 0.003) and incontinence
(22% vs 11%, p 0.01) than men. Women were less often on lipid-lowering therapy on admission.
Echocardiography and carotid investigations were less frequently performed in women due
to greater age and stroke severity. Women had greater 28-day mortality (32% vs 21%, p
0.001) and stroke severity (44% vs 36%, p0.01) than men, but adjustment for age, comorbidities,
and stroke severity (for mortality only) completely attenuated these associations.
Conclusion: Sex differences seen in this study were mostly explained by womens older age,
greater comorbidity, and stroke severity. The reasons for differences according to age may need