Sex differences in management and outcome after stroke: a Swedish national perspective.
OBJECTIVE
It is disputed whether there are sex differences in management and outcome after stroke; early studies have shown inconsistent results. The objective of this study was to verify and explain differences between men and women in management and outcome after stroke in a national perspective.


METHODS
In 2001, 20 761 stroke patients were registered in Riks-Stroke, the national quality register for stroke care in Sweden in which all 84 hospitals participate. Data from 9 hospitals that had reported <70% of the estimated stroke events were excluded from analyses, leaving 19 547 patients (9666 women, 9881 men) at 75 hospitals for the present analyses.


RESULTS
Women were older than men (77.8 versus 73.2 years). After age adjustment, female patients were more often disabled, living at home with community support, or in institutions before the stroke. They also had a different cardiovascular risk factor profile. Case fatality ratios during the first 3 months were similar in men and women. After 3 months, more women were physically and mentally impaired and dependent on other persons. Female patients with atrial fibrillation received oral anticoagulants less often than men. Even after multiple adjustments for differences between sexes, female sex was independently associated with institutional living 3 months after the stroke (odds ratio, 1.2; 95% confidence interval, 1.0 to 1.4).


CONCLUSIONS
Women have a worse prestroke condition. Except for case fatality ratios, they also have a worse outcome after stroke after adjustment for other prognostic factors. There are also sex differences in the medical management of stroke that need to be rectified.
Glader
Eva-Lotta
EL
Department of Public Health and Clinical Medicine, University Hospital Umeå, S-901 95 Umeå, Sweden. eva-lotta.glader@medicin.umu.se
Stegmayr
Birgitta
B
Norrving
Bo
B
Terént
Andreas
A
Hulter-Asberg
Kerstin
K
Wester
Per-Olov
PO
Asplund
Kjell
K
D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000453:epidemiology; D015897:Comorbidity; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D005500:Follow-Up Studies; D006757:Hospital Units / Q000592:standards*; D006801:Humans; D016015:Logistic Models; D008134:Long-Term Care / Q000592:standards; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data*; D011379:Prognosis; D012042:Registries / Q000706:statistics & numerical data; D012307:Risk Factors; D012737:Sex Factors; D020521:Stroke / Q000175:diagnosis / Q000401:mortality; D000071939:Stroke Rehabilitation; D013548:Sweden / Q000453:epidemiology
D000925:Anticoagulants; D005343:Fibrinolytic Agents