Gender comparisons of diagnostic evaluation for ischemic stroke patients.
BACKGROUND
Sixty-two percent of all stroke deaths in the United States occur in women. We compared diagnostic evaluations by gender in ischemic stroke patients in a biethnic, population-based study.


METHODS
A random sample of patients with ischemic stroke identified between 2000 and 2002 by BASIC (Brain Attack Surveillance in Corpus Christi Project) were selected for this study (n = 381). Gender differences in the use of stroke diagnostic tests were assessed. Separate multivariable logistic regression models predicting diagnostic test use were constructed, adjusted for age, ethnicity, hypertension, atrial fibrillation, diabetes, history of stroke, coronary artery disease, having a primary care provider, discharge disposition, modified Rankin Scale score at discharge, and insurance status.


RESULTS
The study population consisted of 161 men and 220 women. Median age was 74.3 years. The respective proportions of males and females receiving any carotid artery evaluation were 71% and 62%; brain MRI, 43% and 41%; echocardiography, 57% and 48%; and EKG, 90% and 86%. Multivariable logistic models found that women were less likely to undergo echocardiography (odds ratio [OR] 0.64, CI: 0.42 to 0.98) and carotid evaluation (OR 0.57, CI: 0.36 to 0.91). There was no association of ischemic stroke subtype and gender to explain these results (p = 0.76).


CONCLUSIONS
Despite controlling for explanatory variables, women with stroke were less likely to receive standard diagnostic tests vs men. Intervention is needed to increase access to quality stroke care for women.
Smith
Melinda A
MA
University of Michigan Health System, Ann Arbor, MI, USA.
Lisabeth
Lynda D
LD
Brown
Devin L
DL
Morgenstern
Lewis B
LB
D000368:Aged; D001921:Brain / Q000098:blood supply / Q000473:pathology* / Q000503:physiopathology; D002545:Brain Ischemia / Q000175:diagnosis* / Q000453:epidemiology; D002318:Cardiovascular Diseases / Q000150:complications / Q000000981:diagnostic imaging / Q000453:epidemiology; D002339:Carotid Arteries / Q000000981:diagnostic imaging* / Q000473:pathology / Q000503:physiopathology; D002536:Cerebral Arteries / Q000000981:diagnostic imaging* / Q000473:pathology / Q000503:physiopathology; D015331:Cohort Studies; D004452:Echocardiography / Q000592:standards / Q000706:statistics & numerical data; D004453:Echoencephalography / Q000592:standards / Q000706:statistics & numerical data; D004562:Electrocardiography / Q000592:standards / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000592:standards / Q000706:statistics & numerical data; D008297:Male; D011787:Quality of Health Care / Q000706:statistics & numerical data* / Q000639:trends; D017678:Sex Distribution; D012737:Sex Factors; D020521:Stroke / Q000175:diagnosis* / Q000453:epidemiology