Sex differences in acute stroke care in a statewide stroke registry.
OBJECTIVE
Many studies have reported poorer stroke outcomes in women, and some studies have reported sex differences in care. We analyzed data from a hospital-based stroke registry to determine whether acute stroke care and discharge status differed by sex.


METHODS
Detailed chart-level information was collected on 2566 subjects admitted for acute stroke or transient ischemic attack to 15 Michigan hospitals in 2002. Sex differences in stroke care and patient status at discharge (in-hospital mortality and modified Rankin Scale score) were assessed after adjusting for differences in demographics, clinical characteristics, and comorbidities by multivariable models. Modified Rankin Scale score data were analyzed by proportional-odds models.


RESULTS
Women were older than men (70 vs 67 years) and were more likely to have congestive heart failure and hypertension. Men were more likely to smoke and have a history of heart disease and dyslipidemia. After multivariable adjustment, women were less likely to receive thrombolytic therapy (odds ratio [OR]=0.56; 95% CI, 0.37 to 0.86) or lipid testing (OR=0.76; 95% CI, 0.61 to 0.94) and were more likely to suffer urinary tract infections (OR=2.57; 95% CI, 1.87 to 3.54). In-hospital mortality was similar in women and men (9% vs 8%); however, women had poorer discharge modified Rankin Scale scores (OR=1.17; 95% CI, 1.01 to 1.35).


CONCLUSIONS
Although considerable parity exists in many aspects of acute stroke care, women were less likely than men to receive thrombolytic treatment and lipid testing, even after adjustment. However, given the largely similar care observed, it is unlikely that differences in care explain the poorer functional outcomes in female stroke survivors.
Department of Epidemiology, College of Human Medicine, Michigan State University, East Lansing, MI, USA.
Julia Warner
JW
Gargano
Susan
S
Wehner
Mathew
M
Reeves
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D050171:Dyslipidemias / Q000150:complications; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006331:Heart Diseases / Q000150:complications; D006333:Heart Failure / Q000150:complications; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D006973:Hypertension / Q000150:complications; D008055:Lipids / Q000097:blood; D008297:Male; D008824:Michigan; D008875:Middle Aged; D011785:Quality Assurance, Health Care; D011787:Quality of Health Care; D012042:Registries / Q000706:statistics & numerical data*; D012727:Sex Characteristics; D020521:Stroke / Q000097:blood / Q000188:drug therapy* / Q000209:etiology; D016896:Treatment Outcome
D005343:Fibrinolytic Agents; D008055:Lipids