Elderly women have lower rates of stroke, cardiovascular events, and mortality after hospitalization for transient ischemic attack.
OBJECTIVE
Patients with transient ischemic attack (TIA) are at increased risk for stroke, cardiovascular events, and death, yet little is known about whether these risks differ for men and women. We determined whether there are sex-based differences in these outcomes 30 days and 1 year after TIA using a national sample of elderly patients.


METHODS
Rates of 30-day and 1-year hospitalization for TIA (International Classification of Diseases, 9th Revision Code 435), stroke (International Classification of Diseases, 9th Revision Codes 433, 434, and 436), coronary artery disease (International Classification of Diseases, 9th Revision Codes 410 to 414), all-cause readmission, and mortality were determined for fee-for-service Medicare patients >or=65 years of age discharged with a TIA in 2002. Cox proportional hazards models and random-effects logistic models compared outcomes with risk adjustment for demographics, medical history, comorbidities, and prior hospitalizations.


RESULTS
The study included 122063 TIA hospitalizations (mean age, 79.0+/-7.6 years; 62% women; 86% white). Men were younger but had higher rates of cardiac comorbidities than women. Women had lower unadjusted rates of stroke, coronary artery disease, and mortality at 30 days and 1 year after TIA admission. These relationships persisted in risk-adjusted analyses at 30 days for stroke (hazard ratio, 0.70; 95% CI, 0.64 to 0.77), coronary artery disease (hazard ratio, 0.86; 0.74 to 1.00), and mortality (odds ratio, 0.74; 0.68 to 0.82) as well as at 1 year for stroke (hazard ratio, 0.85; 0.81 to 0.89), coronary artery disease (hazard ratio, 0.81; 0.77 to 0.86), and mortality (odds ratio, 0.78; 0.75 to 0.81).


CONCLUSIONS
These data suggest that women have a better prognosis than men within the first year after hospital discharge for a TIA. Additional research is needed to identify factors that may explain these sex-related differences in outcomes.
Lichtman
Judith H
JH
Department of Epidemiology and Public Health, Yale University School of Medicine, PO Box 208034, New Haven, CT 06520-8034, USA. Judith.Lichtman@yale.edu
Jones
Sara B
SB
Watanabe
Emi
E
Allen
Norrina B
NB
Wang
Yun
Y
Howard
Virginia J
VJ
Goldstein
Larry B
LB
D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000401:mortality; D015331:Cohort Studies; D005260:Female; D006760:Hospitalization; D006801:Humans; D002546:Ischemic Attack, Transient / Q000453:epidemiology* / Q000401:mortality; D016017:Odds Ratio; D011379:Prognosis; D016016:Proportional Hazards Models; D012008:Recurrence; D020521:Stroke / Q000453:epidemiology* / Q000401:mortality; D016019:Survival Analysis; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology