title: Gender differences in stroke care and outcomes in Ontario.
abstract: BACKGROUND
  Studies of potential gender differences in stroke care and outcomes have yielded inconsistent findings. The Project for an Ontario Women's Health Evidence-based Report study measured established stroke care indicators in a large, representative sample of women and men with stroke or transient ischemic attack (TIA) admitted to acute care institutions in the province of Ontario, Canada.
  
  
  METHODS
  The Registry of the Canadian Stroke Network performs a biennial audit on a random sample of 20% of patients with stroke or TIA seen at more than 150 acute care institutions across Ontario. We used data from the 2004/05 audit to compare stroke care by gender, with stratification by age and neighborhood income.
  
  
  RESULTS
  The sample consisted of 4,046 patients (51% women). There were no significant gender differences in the use of thrombolysis, neuroimaging, carotid imaging, dysphagia screening, antithrombotic therapy, or neurology and other consultations. Women with ischemic stroke or TIA were less likely than men to be prescribed statins or undergo carotid imaging and endarterectomy within 6 months of stroke; women were more likely than men to receive antihypertensives. There were no significant gender differences in readmission or mortality rates after stroke.
  
  
  CONCLUSIONS
  In this population-based study, we found little evidence of gender differences in stroke care or outcomes other than lipid-lowering therapy, carotid imaging, and endarterectomy. Further study is needed to assess the contribution of the provincial stroke strategy in eliminating gender differences in management of acute stroke and to better understand and target remaining gender differences in management.
authors.affiliation: Department of Medicine, University of Toronto, Toronto General Hospital, 200 Elizabeth St., Toronto, Ontario, Canada. moira.kapral@uhn.on.ca
authors.forename: Moira K
authors.initials: MK
authors.lastname: Kapral
authors.forename: Naushaba
authors.initials: N
authors.lastname: Degani
authors.forename: Ruth
authors.initials: R
authors.lastname: Hall
authors.forename: Jiming
authors.initials: J
authors.lastname: Fang
authors.forename: Gustavo
authors.initials: G
authors.lastname: Saposnik
authors.forename: Janice
authors.initials: J
authors.lastname: Richards
authors.forename: Frank L
authors.initials: FL
authors.lastname: Silver
authors.forename: Annette
authors.initials: A
authors.lastname: Robertson
authors.forename: Arlene S
authors.initials: AS
authors.lastname: Bierman
mesh_terms: D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000627:therapeutic use; D004691:Endarterectomy / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D015994:Incidence; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D009864:Ontario / Q000453:epidemiology; D010043:Outcome and Process Assessment, Health Care; D019984:Quality Indicators, Health Care; D012042:Registries / Q000706:statistics & numerical data; D012307:Risk Factors; D017678:Sex Distribution; D012737:Sex Factors; D012931:Social Environment; D012959:Socioeconomic Factors; D020521:Stroke / Q000145:classification / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D015912:Thrombolytic Therapy / Q000706:statistics & numerical data; D013997:Time Factors
chemical_list: D000959:Antihypertensive Agents; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors