title: 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.
abstract: 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.
authors.affiliation: Institute of Neurosciences, ILSA Study, Italian National Research Council, Florence, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Di Carlo
authors.forename: Maria
authors.initials: M
authors.lastname: Lamassa
authors.forename: Marzia
authors.initials: M
authors.lastname: Baldereschi
authors.forename: Giovanni
authors.initials: G
authors.lastname: Pracucci
authors.forename: Anna Maria
authors.initials: AM
authors.lastname: Basile
authors.forename: Charles D A
authors.initials: CD
authors.lastname: Wolfe
authors.forename: Maurice
authors.initials: M
authors.lastname: Giroud
authors.forename: Anthony
authors.initials: A
authors.lastname: Rudd
authors.forename: Augusto
authors.initials: A
authors.lastname: Ghetti
authors.forename: Domenico
authors.initials: D
authors.lastname: Inzitari
mesh_terms: 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
chemical_list: D002317:Cardiovascular Agents; D007004:Hypoglycemic Agents