title: Sex Disparities in Ischemic Stroke Care: FL-PR CReSD Study (Florida-Puerto Rico Collaboration to Reduce Stroke Disparities).
abstract: Sex-specific disparities in stroke care including thrombolytic therapy and early hospital admission are reported. In a large registry of Florida and Puerto Rico hospitals participating in the Get With The Guidelines-Stroke program, we sought to determine sex-specific differences in ischemic stroke performance metrics and overall thrombolytic treatment.
  
  
  
  Around 51 317 (49% women) patients were included from 73 sites from 2010 to 2014. Multivariable logistic regression with generalized estimating equations evaluated sex-specific differences in the prespecified Get With The Guidelines-Stroke metrics for defect-free care in ischemic stroke, adjusting for age, race-ethnicity, insurance status, hospital characteristics, individual risk factors, and the presenting stroke severity.
  
  
  
  As compared with men, women were older (73±15 versus 69±14 years; P<0.0001), more hypertensive (67% versus 63%, P<0.0001), and had more atrial fibrillation (19% versus 16%; P<0.0001). Defect-free care was slightly lower in women than in men (odds ratio, 0.96; 95% confidence interval, 0.93-1.00). Temporal trends in defect-free care improved substantially and similarly for men and women, with a 29% absolute improvement in women (P<0.0001) and 28% in men (P<0.0001), with P value of 0.13 for time-by-sex interaction. Women were less likely to receive thrombolysis (odds ratio, 0.92; 95% confidence interval, 0.86-0.99; P=0.02) and less likely to have a door-to-needle time <1 hour (odds ratio, 0.83; 95% confidence interval, 0.71-0.97; P=0.02) as compared with men.
  
  
  
  Women received comparable stroke care to men in this registry as measured by prespecified Get With The Guidelines metrics. However, women less likely received thrombolysis and had door-to-needle time <1 hour, an observation that calls for the implementation of interventions to reduce sex disparity in these measures.
authors.affiliation: From the Department of Neurology, University of Miami Miller School of Medicine, FL (N.A., J.G.R., K.W., M.A.C-.V., S.K., H.G., C.D., R.L.S., T.R.); Department of Neurology, University of South Florida School of Medicine, Tampa (D.Z.R., W.S.B.); National Institute of Neurological Disorders and Stroke, Bethesda, MD (S.P.W.); The American Heart Association, Greater Southeast Affiliate, Marietta, GA (M.R.); and Endowed Health Services Research Center (E.J.G.) and Department of Emergency Medicine (J.A.G-.S.), University of Puerto Rico School of Medicine, San Juan. nasdaghi@med.miami.edu.
authors.forename: Negar
authors.initials: N
authors.lastname: Asdaghi
authors.affiliation: From the Department of Neurology, University of Miami Miller School of Medicine, FL (N.A., J.G.R., K.W., M.A.C-.V., S.K., H.G., C.D., R.L.S., T.R.); Department of Neurology, University of South Florida School of Medicine, Tampa (D.Z.R., W.S.B.); National Institute of Neurological Disorders and Stroke, Bethesda, MD (S.P.W.); The American Heart Association, Greater Southeast Affiliate, Marietta, GA (M.R.); and Endowed Health Services Research Center (E.J.G.) and Department of Emergency Medicine (J.A.G-.S.), University of Puerto Rico School of Medicine, San Juan.
authors.forename: Jose G
authors.initials: JG
authors.lastname: Romano
authors.affiliation: From the Department of Neurology, University of Miami Miller School of Medicine, FL (N.A., J.G.R., K.W., M.A.C-.V., S.K., H.G., C.D., R.L.S., T.R.); Department of Neurology, University of South Florida School of Medicine, Tampa (D.Z.R., W.S.B.); National Institute of Neurological Disorders and Stroke, Bethesda, MD (S.P.W.); The American Heart Association, Greater Southeast Affiliate, Marietta, GA (M.R.); and Endowed Health Services Research Center (E.J.G.) and Department of Emergency Medicine (J.A.G-.S.), University of Puerto Rico School of Medicine, San Juan.
authors.forename: Kefeng
authors.initials: K
authors.lastname: Wang
authors.affiliation: From the Department of Neurology, University of Miami Miller School of Medicine, FL (N.A., J.G.R., K.W., M.A.C-.V., S.K., H.G., C.D., R.L.S., T.R.); Department of Neurology, University of South Florida School of Medicine, Tampa (D.Z.R., W.S.B.); National Institute of Neurological Disorders and Stroke, Bethesda, MD (S.P.W.); The American Heart Association, Greater Southeast Affiliate, Marietta, GA (M.R.); and Endowed Health Services Research Center (E.J.G.) and Department of Emergency Medicine (J.A.G-.S.), University of Puerto Rico School of Medicine, San Juan.
authors.forename: Maria A
authors.initials: MA
authors.lastname: Ciliberti-Vargas
authors.affiliation: From the Department of Neurology, University of Miami Miller School of Medicine, FL (N.A., J.G.R., K.W., M.A.C-.V., S.K., H.G., C.D., R.L.S., T.R.); Department of Neurology, University of South Florida School of Medicine, Tampa (D.Z.R., W.S.B.); National Institute of Neurological Disorders and Stroke, Bethesda, MD (S.P.W.); The American Heart Association, Greater Southeast Affiliate, Marietta, GA (M.R.); and Endowed Health Services Research Center (E.J.G.) and Department of Emergency Medicine (J.A.G-.S.), University of Puerto Rico School of Medicine, San Juan.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Koch
authors.affiliation: From the Department of Neurology, University of Miami Miller School of Medicine, FL (N.A., J.G.R., K.W., M.A.C-.V., S.K., H.G., C.D., R.L.S., T.R.); Department of Neurology, University of South Florida School of Medicine, Tampa (D.Z.R., W.S.B.); National Institute of Neurological Disorders and Stroke, Bethesda, MD (S.P.W.); The American Heart Association, Greater Southeast Affiliate, Marietta, GA (M.R.); and Endowed Health Services Research Center (E.J.G.) and Department of Emergency Medicine (J.A.G-.S.), University of Puerto Rico School of Medicine, San Juan.
authors.forename: Hannah
authors.initials: H
authors.lastname: Gardener
authors.affiliation: From the Department of Neurology, University of Miami Miller School of Medicine, FL (N.A., J.G.R., K.W., M.A.C-.V., S.K., H.G., C.D., R.L.S., T.R.); Department of Neurology, University of South Florida School of Medicine, Tampa (D.Z.R., W.S.B.); National Institute of Neurological Disorders and Stroke, Bethesda, MD (S.P.W.); The American Heart Association, Greater Southeast Affiliate, Marietta, GA (M.R.); and Endowed Health Services Research Center (E.J.G.) and Department of Emergency Medicine (J.A.G-.S.), University of Puerto Rico School of Medicine, San Juan.
authors.forename: Chuanhui
authors.initials: C
authors.lastname: Dong
authors.affiliation: From the Department of Neurology, University of Miami Miller School of Medicine, FL (N.A., J.G.R., K.W., M.A.C-.V., S.K., H.G., C.D., R.L.S., T.R.); Department of Neurology, University of South Florida School of Medicine, Tampa (D.Z.R., W.S.B.); National Institute of Neurological Disorders and Stroke, Bethesda, MD (S.P.W.); The American Heart Association, Greater Southeast Affiliate, Marietta, GA (M.R.); and Endowed Health Services Research Center (E.J.G.) and Department of Emergency Medicine (J.A.G-.S.), University of Puerto Rico School of Medicine, San Juan.
authors.forename: David Z
authors.initials: DZ
authors.lastname: Rose
authors.affiliation: From the Department of Neurology, University of Miami Miller School of Medicine, FL (N.A., J.G.R., K.W., M.A.C-.V., S.K., H.G., C.D., R.L.S., T.R.); Department of Neurology, University of South Florida School of Medicine, Tampa (D.Z.R., W.S.B.); National Institute of Neurological Disorders and Stroke, Bethesda, MD (S.P.W.); The American Heart Association, Greater Southeast Affiliate, Marietta, GA (M.R.); and Endowed Health Services Research Center (E.J.G.) and Department of Emergency Medicine (J.A.G-.S.), University of Puerto Rico School of Medicine, San Juan.
authors.forename: Salina P
authors.initials: SP
authors.lastname: Waddy
authors.affiliation: From the Department of Neurology, University of Miami Miller School of Medicine, FL (N.A., J.G.R., K.W., M.A.C-.V., S.K., H.G., C.D., R.L.S., T.R.); Department of Neurology, University of South Florida School of Medicine, Tampa (D.Z.R., W.S.B.); National Institute of Neurological Disorders and Stroke, Bethesda, MD (S.P.W.); The American Heart Association, Greater Southeast Affiliate, Marietta, GA (M.R.); and Endowed Health Services Research Center (E.J.G.) and Department of Emergency Medicine (J.A.G-.S.), University of Puerto Rico School of Medicine, San Juan.
authors.forename: Mary
authors.initials: M
authors.lastname: Robichaux
authors.affiliation: From the Department of Neurology, University of Miami Miller School of Medicine, FL (N.A., J.G.R., K.W., M.A.C-.V., S.K., H.G., C.D., R.L.S., T.R.); Department of Neurology, University of South Florida School of Medicine, Tampa (D.Z.R., W.S.B.); National Institute of Neurological Disorders and Stroke, Bethesda, MD (S.P.W.); The American Heart Association, Greater Southeast Affiliate, Marietta, GA (M.R.); and Endowed Health Services Research Center (E.J.G.) and Department of Emergency Medicine (J.A.G-.S.), University of Puerto Rico School of Medicine, San Juan.
authors.forename: Enid J
authors.initials: EJ
authors.lastname: Garcia
authors.affiliation: From the Department of Neurology, University of Miami Miller School of Medicine, FL (N.A., J.G.R., K.W., M.A.C-.V., S.K., H.G., C.D., R.L.S., T.R.); Department of Neurology, University of South Florida School of Medicine, Tampa (D.Z.R., W.S.B.); National Institute of Neurological Disorders and Stroke, Bethesda, MD (S.P.W.); The American Heart Association, Greater Southeast Affiliate, Marietta, GA (M.R.); and Endowed Health Services Research Center (E.J.G.) and Department of Emergency Medicine (J.A.G-.S.), University of Puerto Rico School of Medicine, San Juan.
authors.forename: Juan A
authors.initials: JA
authors.lastname: Gonzalez-Sanchez
authors.affiliation: From the Department of Neurology, University of Miami Miller School of Medicine, FL (N.A., J.G.R., K.W., M.A.C-.V., S.K., H.G., C.D., R.L.S., T.R.); Department of Neurology, University of South Florida School of Medicine, Tampa (D.Z.R., W.S.B.); National Institute of Neurological Disorders and Stroke, Bethesda, MD (S.P.W.); The American Heart Association, Greater Southeast Affiliate, Marietta, GA (M.R.); and Endowed Health Services Research Center (E.J.G.) and Department of Emergency Medicine (J.A.G-.S.), University of Puerto Rico School of Medicine, San Juan.
authors.forename: W Scott
authors.initials: WS
authors.lastname: Burgin
authors.affiliation: From the Department of Neurology, University of Miami Miller School of Medicine, FL (N.A., J.G.R., K.W., M.A.C-.V., S.K., H.G., C.D., R.L.S., T.R.); Department of Neurology, University of South Florida School of Medicine, Tampa (D.Z.R., W.S.B.); National Institute of Neurological Disorders and Stroke, Bethesda, MD (S.P.W.); The American Heart Association, Greater Southeast Affiliate, Marietta, GA (M.R.); and Endowed Health Services Research Center (E.J.G.) and Department of Emergency Medicine (J.A.G-.S.), University of Puerto Rico School of Medicine, San Juan.
authors.forename: Ralph L
authors.initials: RL
authors.lastname: Sacco
authors.affiliation: From the Department of Neurology, University of Miami Miller School of Medicine, FL (N.A., J.G.R., K.W., M.A.C-.V., S.K., H.G., C.D., R.L.S., T.R.); Department of Neurology, University of South Florida School of Medicine, Tampa (D.Z.R., W.S.B.); National Institute of Neurological Disorders and Stroke, Bethesda, MD (S.P.W.); The American Heart Association, Greater Southeast Affiliate, Marietta, GA (M.R.); and Endowed Health Services Research Center (E.J.G.) and Department of Emergency Medicine (J.A.G-.S.), University of Puerto Rico School of Medicine, San Juan.
authors.forename: Tatjana
authors.initials: T
authors.lastname: Rundek
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000175:diagnosis / Q000188:drug therapy*; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D054625:Healthcare Disparities; D006801:Humans; D008297:Male; D008875:Middle Aged; D012042:Registries; D012307:Risk Factors; D012720:Severity of Illness Index; D012737:Sex Factors; D020521:Stroke / Q000175:diagnosis / Q000188:drug therapy*; D015912:Thrombolytic Therapy; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
keywords: Get With The Guidelines; National Institute of Neurological Disorders and Stroke; sex characteristics; stroke