Evidence for age and sex differences in the secondary prevention of stroke in Scottish primary care.
OBJECTIVE
Secondary preventive measures play an important role in the reduction of stroke, the third largest cause of death in Scotland. We investigated whether sex, age, or deprivation differences existed in the secondary prevention of stroke in primary care.


METHODS
A retrospective cross-sectional study using a computerized database with 61 practices (377,439 patients) to identify group differences in secondary preventive therapy between March 2003 and April 2004 for 10,076 patients with a diagnosis of any stroke.


RESULTS
Women with any stroke were more likely than men to be prescribed a thiazide (odds ratios [OR], 1.60; 95% confidence interval [CI], 1.46 to 1.75) but less likely to be prescribed an angiotensin-converting enzyme inhibitor (OR, 0.73; 95% CI, 0.67 to 0.81). Women with ischemic stroke were less likely to receive either an antiplatelet or warfarin (OR, 0.84; 95% CI, 0.75 to 0.94) or statin therapy (OR, 0.82; 95% CI, 0.74 to 0.90) than men. Women with atrial fibrillation received less warfarin (OR, 0.62; 95% CI, 0.48 to 0.81) but more antiplatelet therapy than men (OR, 1.30; 95% CI, 1.00 to 1.68). The oldest patients (older than 75 years) with ischemic stroke received more antiplatelet therapy than the youngest patients (younger than 65 years) (OR, 1.83; 95% CI, 1.64 to 2.06). No significant differences in secondary preventative treatment across deprivation groups were found.


CONCLUSIONS
Important sex and age differences exist in the care of patients with stroke and suggest that women and the elderly need to be targeted for secondary prevention therapy.
Simpson
C R
CR
Department of General Practice & Primary Care, Foresterhill Health Centre, Westburn Road, The University of Aberdeen, AB25 2AY, UK. c.simp@abdn.ac.uk
Wilson
C
C
Hannaford
P C
PC
Williams
D
D
D000367:Age Factors; D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000494:pharmacology; D000925:Anticoagulants / Q000494:pharmacology; D000959:Antihypertensive Agents / Q000494:pharmacology; D005260:Female; D006801:Humans; D007511:Ischemia / Q000473:pathology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010975:Platelet Aggregation Inhibitors / Q000494:pharmacology; D011320:Primary Health Care / Q000379:methods*; D012189:Retrospective Studies; D012606:Scotland; D012737:Sex Factors; D020521:Stroke / Q000453:epidemiology / Q000473:pathology / Q000517:prevention & control*; D014859:Warfarin / Q000494:pharmacology
D000806:Angiotensin-Converting Enzyme Inhibitors; D000925:Anticoagulants; D000959:Antihypertensive Agents; D010975:Platelet Aggregation Inhibitors; D014859:Warfarin