title: Gender disparities and thrombolysis use among patient with first-ever ischemic stroke in Malaysia.
abstract: OBJECTIVE
  Gender as an independent predictor in stroke has been well documented. However, data on gender differences among first-ever ischemic stroke in developing country are limited. We aim to describe gender effects on clinical characteristics, thrombolysis treatment received, and outcomes of patients with first-ever ischemic stroke.
  
  
  METHODS
  Data were extracted from the prospective multiethnic stroke registry, National Neurology Registry (NNEUR). Descriptive analysis and logistic regression were performed.
  
  
  RESULTS
  A total of 4762 first-ever ischemic stroke patients admitted to 13 government hospitals from July 2009 to June 2015 were available for this study. Slightly over half were male (55.1%), and they were 1.7 years younger than female (mean age, 63.6 versus 61.9 years, p < 0.001). Gender-age-adjusted incidence was observed to be higher in females (66.7 per 100,000) compared to males (57.4 per 100,000). First-ever ischemic stroke incidence increased by 24.3 and 11.2% among female and male annually. Female experienced significantly poorer functional outcome and greater 30-day in-hospital mortality compared to male. In subgroup analysis, only 31 (0.65%) patients were treated with thrombolysis.
  
  
  CONCLUSIONS
  First-ever ischemic stroke incidence increased by 24.3 and 11.2% among female and male annually. There were distinct symptoms at hospital presentation between genders. All our patients discharged home regardless of genders. In summary, Malaysian female first-ever ischemic stroke was older, present with severe stroke, greater number of risk factors and poorer functional outcome and 30-day in-hospital mortality compared to male.
authors.affiliation: a Department of Neurology and Clinical Research Centre , Hospital Sultanah Nur Zahirah , Kuala Terengganu , Malaysia.
authors.forename: Zariah A
authors.initials: ZA
authors.lastname: Aziz
authors.affiliation: b Health and Value, Pfizer Malaysia , Level 10 & 11, Wisma Averis , Kuala Lumpur , Malaysia.
authors.forename: Yvonne Yl
authors.initials: YY
authors.lastname: Lee
authors.affiliation: d Board of Management , Hospital Sultan Haji Ahmad Shah , Temerloh , Malaysia.
authors.forename: Norsima Nazifah
authors.initials: NN
authors.lastname: Sidek
authors.affiliation: c Department of Pharmacy , Hospital Sultanah Nur Zahirah , Kuala Terengganu , Malaysia.
authors.forename: Bahari Awang
authors.initials: BA
authors.lastname: Ngah
authors.affiliation: e Department of Medicine and Clinical Research Centre , Hospital Seberang Jaya , Prai , Malaysia.
authors.forename: Irene
authors.initials: I
authors.lastname: Looi
authors.affiliation: f Department of Neurology , Hospital Kuala Lumpur , Kuala Lumpur , Malaysia.
authors.forename: Md Rafia
authors.initials: MR
authors.lastname: Hanip
authors.affiliation: g Faculty of Medicine & Health Sciences, Department of Medicine , Universiti Putra Malaysia , Kuala Lumpur , Malaysia.
authors.forename: Hamidon B
authors.initials: HB
authors.lastname: Basri
mesh_terms: D000368:Aged; D002545:Brain Ischemia / Q000150:complications / Q000453:epidemiology; D005260:Female; D006801:Humans; D016015:Logistic Models; D008296:Malaysia / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D012727:Sex Characteristics; D020521:Stroke / Q000453:epidemiology* / Q000209:etiology / Q000628:therapy*; D015912:Thrombolytic Therapy / Q000379:methods*
keywords: Clinical; Disparities; Gender; Ischemic; Predictor; Registry