Sex differences in the clinical presentation, resource use, and 3-month outcome of acute stroke in Europe: data from a multicenter multinational hospital-based registry.
OBJECTIVE
The information on the existence of sex differences in management of stroke patients is scarce. We evaluated whether sex differences may influence clinical presentation, resource use, and outcome of stroke in a European multicenter study.


METHODS
In a European Concerted Action involving 7 countries, 4499 patients hospitalized for first-in-a-lifetime stroke were evaluated for demographics, risk factors, clinical presentation, resource use, and 3-month survival, disability (Barthel Index), and handicap (Rankin Scale).


RESULTS
Overall, 2239 patients were males and 2260 females. Compared with males, female patients were significantly older (mean age 74.5+/-12.5 versus 69.2+/-12.1 years), more frequently institutionalized before stroke, and with a worse prestroke Rankin score (all values P<0.001). History of hypertension (P=0.007) and atrial fibrillation (P<0.001) were significantly more frequent in female stroke patients, as were coma (P<0.001), paralysis (P<0.001), aphasia (P=0.001), swallowing problems (P=0.005), and urinary incontinence (P<0.001) in the acute phase. Brain imaging, Doppler examination, echocardiogram, and angiography were significantly less frequently performed in female than male patients (all values P<0.001). The frequency of carotid surgery was also significantly lower in female patients (P<0.001). At the 3-month follow-up, after controlling for all baseline and clinical variables, female sex was a significant predictor of disability (odds ratio [OR], 1.41; 95% CI 1.10 to 1.81) and handicap (OR, 1.46; 95% CI 1.14 to 1.86). No significant gender effect was observed on 3-month survival.


CONCLUSIONS
Sex-specific differences existed in a large European study of hospital admissions for acute stroke. Both medical and sociodemographic factors may significantly influence stroke outcome. Knowledge of these determinants may positively impact quality of care.
Di Carlo
Antonio
A
Institute of Neurosciences, ILSA Study, Italian National Research Council, Florence, Italy.
Lamassa
Maria
M
Baldereschi
Marzia
M
Pracucci
Giovanni
G
Basile
Anna Maria
AM
Wolfe
Charles D A
CD
Giroud
Maurice
M
Rudd
Anthony
A
Ghetti
Augusto
A
Inzitari
Domenico
D
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000428:Alcohol Drinking / Q000453:epidemiology; D001281:Atrial Fibrillation / Q000453:epidemiology; D001925:Brain Damage, Chronic / Q000453:epidemiology / Q000209:etiology; D002545:Brain Ischemia / Q000150:complications / Q000453:epidemiology / Q000534:rehabilitation / Q000628:therapy*; D002317:Cardiovascular Agents / Q000627:therapeutic use; D019090:Case Management / Q000706:statistics & numerical data*; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000453:epidemiology; D003952:Diagnostic Imaging / Q000706:statistics & numerical data; D005060:Europe / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D015600:Glasgow Coma Scale; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007326:Institutionalization / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology; D010351:Patient Discharge / Q000706:statistics & numerical data; D011379:Prognosis; D012042:Registries / Q000706:statistics & numerical data; D012307:Risk Factors; D012720:Severity of Illness Index; D012737:Sex Factors; D012907:Smoking / Q000453:epidemiology; D020521:Stroke / Q000150:complications / Q000453:epidemiology / Q000628:therapy*; D000071939:Stroke Rehabilitation; D013345:Subarachnoid Hemorrhage / Q000150:complications / Q000453:epidemiology / Q000534:rehabilitation / Q000628:therapy; D016019:Survival Analysis; D016896:Treatment Outcome
D002317:Cardiovascular Agents; D007004:Hypoglycemic Agents