Cheryl Carcel1, Xia Wang2, Else Charlotte Sandset2, Candice Delcourt2, Hisatomi Arima2, Richard Lindley2, Maree L Hackett2, Pablo Lavados2, Thompson G Robinson2, Paula Muñoz Venturelli2, Verónica V Olavarría2, Alejandro Brunser2, Eivind Berge2, John Chalmers2, Mark Woodward2, Craig S Anderson2. 1. From The George Institute for Global Health (C.C., X.W., C.D., M.L.H., P.M.V., J.C., M.W., C.S.A.), University of New South Wales, Sydney; Sydney School of Public Health, Sydney Medical School (C.C., X.W., C.D., M.L.H., C.S.A.), The University of Sydney, New South Wales, Australia; Departments of Neurology (E.C.S.) and Internal Medicine (E.B.), Oslo University Hospital; Department of Research and Development (E.C.S.), The Norwegian Air Ambulance Foundation, Oslo, Norway; Department of Neurology (C.D.), Royal Prince Alfred Hospital, Sydney, Australia; Department of Public Health (H.A.), Fukuoka University, Japan; The George Institute for Global Health and Westmead Clinical School (R.L.), University of Sydney, Australia; Faculty of Health and Wellbeing (M.L.H.), The University of Central Lancashire, Preston, UK; Unidad de Neurología Vascular (P.L., P.M.V., V.V.O., A.B.), Servicio de Neurología, Departamento de Neurología y Psiquiatría, Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago; Departamento de Ciencias Neurológicas (P.L.), Facultad de Medicina, Universidad de Chile; Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Centre (T.G.R.), University of Leicester, UK; Centro de Estudios Clínicos (P.M.V.), Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago; Departamento de Paciente Crítico (V.V.O.), Clínica Alemana de Santiago, Chile; The George Institute for Global Health (M.W.), University of Oxford, UK; Department of Epidemiology (M.W.), Johns Hopkins University, Baltimore, MD; and The George Institute China at Peking University Health Science Centre (C.S.A.), Beijing, China. ccarcel@georgeinstitute.org.au. 2. From The George Institute for Global Health (C.C., X.W., C.D., M.L.H., P.M.V., J.C., M.W., C.S.A.), University of New South Wales, Sydney; Sydney School of Public Health, Sydney Medical School (C.C., X.W., C.D., M.L.H., C.S.A.), The University of Sydney, New South Wales, Australia; Departments of Neurology (E.C.S.) and Internal Medicine (E.B.), Oslo University Hospital; Department of Research and Development (E.C.S.), The Norwegian Air Ambulance Foundation, Oslo, Norway; Department of Neurology (C.D.), Royal Prince Alfred Hospital, Sydney, Australia; Department of Public Health (H.A.), Fukuoka University, Japan; The George Institute for Global Health and Westmead Clinical School (R.L.), University of Sydney, Australia; Faculty of Health and Wellbeing (M.L.H.), The University of Central Lancashire, Preston, UK; Unidad de Neurología Vascular (P.L., P.M.V., V.V.O., A.B.), Servicio de Neurología, Departamento de Neurología y Psiquiatría, Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago; Departamento de Ciencias Neurológicas (P.L.), Facultad de Medicina, Universidad de Chile; Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Centre (T.G.R.), University of Leicester, UK; Centro de Estudios Clínicos (P.M.V.), Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago; Departamento de Paciente Crítico (V.V.O.), Clínica Alemana de Santiago, Chile; The George Institute for Global Health (M.W.), University of Oxford, UK; Department of Epidemiology (M.W.), Johns Hopkins University, Baltimore, MD; and The George Institute China at Peking University Health Science Centre (C.S.A.), Beijing, China.
Abstract
OBJECTIVE: To explore the sex differences in outcomes and management after stroke using a large sample with high-quality international trial data. METHODS: Individual participant data were obtained from 5 acute stroke randomized controlled trials. Data were obtained on demographics, medication use, in-hospital treatment, and functional outcome. Study-specific crude and adjusted models were used to estimate sex differences in outcomes and management, and then pooled using random-effects meta-analysis. RESULTS: There were 19,652 participants, of whom 7,721 (40%) were women. After multivariable adjustments, women with ischemic stroke had higher survival at 3-6 months (odds ratio [OR] 0.82, 95% confidence interval [CI] 0.70-0.97), higher likelihood of disability (OR 1.20, 95% CI 1.06-1.36), and worse quality of life (weighted mean difference -0.07, 95% CI -0.09 to 0.04). For management, women were more likely to be admitted to an acute stroke unit (OR 1.17, 95% CI 1.01-1.34), but less likely to be intubated (OR 0.58, 95% CI 0.36-0.93), treated for fever (OR 0.82, 95% CI 0.70-0.95), or admitted to an intensive care unit (OR 0.83, 95% CI 0.74-0.93). For preadmission medications, women had higher odds of being prescribed antihypertensive agents (OR 1.22, 95% CI 1.13-1.31) and lower odds of being prescribed antiplatelets (OR 0.86, 95% CI 0.79-0.93), glucose-lowering agents (OR 0.86, 95% CI 0.78-0.94), or lipid-lowering agents (OR 0.85, 95% CI 0.77-0.94). CONCLUSIONS: This analysis suggests that women who had ischemic stroke had better survival but were also more disabled and had poorer quality of life. Variations in hospital and out-of-hospital management may partly explain the disparities.
OBJECTIVE: To explore the sex differences in outcomes and management after stroke using a large sample with high-quality international trial data. METHODS: Individual participant data were obtained from 5 acute stroke randomized controlled trials. Data were obtained on demographics, medication use, in-hospital treatment, and functional outcome. Study-specific crude and adjusted models were used to estimate sex differences in outcomes and management, and then pooled using random-effects meta-analysis. RESULTS: There were 19,652 participants, of whom 7,721 (40%) were women. After multivariable adjustments, women with ischemic stroke had higher survival at 3-6 months (odds ratio [OR] 0.82, 95% confidence interval [CI] 0.70-0.97), higher likelihood of disability (OR 1.20, 95% CI 1.06-1.36), and worse quality of life (weighted mean difference -0.07, 95% CI -0.09 to 0.04). For management, women were more likely to be admitted to an acute stroke unit (OR 1.17, 95% CI 1.01-1.34), but less likely to be intubated (OR 0.58, 95% CI 0.36-0.93), treated for fever (OR 0.82, 95% CI 0.70-0.95), or admitted to an intensive care unit (OR 0.83, 95% CI 0.74-0.93). For preadmission medications, women had higher odds of being prescribed antihypertensive agents (OR 1.22, 95% CI 1.13-1.31) and lower odds of being prescribed antiplatelets (OR 0.86, 95% CI 0.79-0.93), glucose-lowering agents (OR 0.86, 95% CI 0.78-0.94), or lipid-lowering agents (OR 0.85, 95% CI 0.77-0.94). CONCLUSIONS: This analysis suggests that women who had ischemic stroke had better survival but were also more disabled and had poorer quality of life. Variations in hospital and out-of-hospital management may partly explain the disparities.
Authors: Kathryn M Rexrode; Tracy E Madsen; Amy Y X Yu; Cheryl Carcel; Judith H Lichtman; Eliza C Miller Journal: Circ Res Date: 2022-02-17 Impact factor: 17.367
Authors: Demilade A Adedinsewo; Amy W Pollak; Sabrina D Phillips; Taryn L Smith; Anna Svatikova; Sharonne N Hayes; Sharon L Mulvagh; Colleen Norris; Veronique L Roger; Peter A Noseworthy; Xiaoxi Yao; Rickey E Carter Journal: Circ Res Date: 2022-02-17 Impact factor: 23.213
Authors: Else Charlotte Sandset; Xia Wang; Cheryl Carcel; Shoichiro Sato; Candice Delcourt; Hisatomi Arima; Christian Stapf; Thompson Robinson; Pablo Lavados; John Chalmers; Mark Woodward; Craig S Anderson Journal: Eur Stroke J Date: 2020-09-20
Authors: Samuel S Bruce; Alexander E Merkler; Meenakshi Bassi; Monica L Chen; Setareh Salehi Omran; Babak B Navi; Hooman Kamel Journal: J Am Heart Assoc Date: 2020-02-28 Impact factor: 5.501