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Title: Factors contributing to sex differences in functional outcomes and participation after stroke.
Austin Authors: Phan, Hoang T;Blizzard, Christopher L;Reeves, Mathew J;Thrift, Amanda G;Cadilhac, Dominique A;Sturm, Jonathan;Heeley, Emma;Otahal, Petr;Vemmos, Konstantinos;Anderson, Craig;Parmar, Priya;Krishnamurthi, Rita;Barker-Collo, Suzanne;Feigin, Valery;Bejot, Yannick;Cabral, Norberto Luiz;Carolei, Antonio;Sacco, Simona;Chausson, Nicolas;Olindo, Stephane;Rothwell, Peter;Silva, Carolina;Correia, Manuel;Magalhães, Rui;Appelros, Peter;Kõrv, Janika;Vibo, Riina;Minelli, Cesar;Gall, Seana L
Affiliation: Menzies Institute for Medical Research Tasmania, University of Tasmania, Hobart, Australia
Department of Health Management and Health Economics, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
Department of Epidemiology and Biostatistics, Michigan State University, East Lansing
Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton
The Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia
University of Melbourne, Victoria, Australia
Faculty of Health and Medicine, University of Newcastle
George Institute for Global Health, University of Sydney, New South Wales, Australia
Hellenic Cardiovascular Research Society, Athens, Greece
National Institute for Stroke and Applied Neurosciences, School of Public Health and Psychosocial Studies, Auckland University of Technology
School of Psychology, University of Auckland, New Zealand
University of Burgundy, University Hospital of Dijon, France
Clinica Neurológica de Joinville, Joinville Stroke Registry, University of Joinville Region, Brazil
Department of Biotechnological and Applied Clinical Sciences, Neurological Institute, University of L'Aquila, Italy
Stroke Unit, Centre Hospitalier Sud Francilien, Corbeil-Essonnes
Stroke Unit, University Hospital of Bordeaux, France
Stroke Prevention Research Unit, Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK
UNIFAI, Instituto de Ciências Biomédicas de Abel Salazar, Universidade do Porto, Portugal
Department of Neurology, Faculty of Medicine and Health, Örebro University, Sweden
Department of Neurology and Neurosurgery, University of Tartu, Estonia
Hospital Carlos Fernando Malzoni and Neurologic Center of Research and Rehabilitation, Matão, SP, Brazil
Issue Date: 2018
Date: 2018-04-27
Publication information: Neurology 2018; 90(22): e1945-e1953
Abstract: To examine factors contributing to the sex differences in functional outcomes and participation restriction after stroke. Individual participant data on long-term functional outcome or participation restriction (i.e., handicap) were obtained from 11 stroke incidence studies (1993-2014). Multivariable log-binomial regression was used to estimate the female:male relative risk (RR) of poor functional outcome (modified Rankin Scale score >2 or Barthel Index score <20) at 1 year (10 studies, n = 4,852) and 5 years (7 studies, n = 2,226). Multivariable linear regression was used to compare the mean difference (MD) in participation restriction by use of the London Handicap Scale (range 0-100 with lower scores indicating poorer outcome) for women compared to men at 5 years (2 studies, n = 617). For each outcome, study-specific estimates adjusted for confounding factors (e.g., sociodemographics, stroke-related factors) were combined with the use of random-effects meta-analysis. In unadjusted analyses, women experienced worse functional outcomes after stroke than men (1 year: pooled RRunadjusted 1.32, 95% confidence interval [CI] 1.18-1.48; 5 years: RRunadjusted 1.31, 95% CI 1.16-1.47). However, this difference was greatly attenuated after adjustment for age, prestroke dependency, and stroke severity (1 year: RRadjusted 1.08, 95% CI 0.97-1.20; 5 years: RRadjusted 1.05, 95% CI 0.94-1.18). Women also had greater participation restriction than men (pooled MDunadjusted -5.55, 95% CI -8.47 to -2.63), but this difference was again attenuated after adjustment for the aforementioned factors (MDadjusted -2.48, 95% CI -4.99 to 0.03). Worse outcomes after stroke among women were explained mostly by age, stroke severity, and prestroke dependency, suggesting these potential targets to improve the outcomes after stroke in women.
DOI: 10.1212/WNL.0000000000005602
ORCID: 0000-0001-8162-682X
Journal: Neurology
PubMed URL: 29703773
Type: Journal Article
Appears in Collections:Journal articles

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