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Title: Sex differences in quality of life after stroke were explained by patient factors, not clinical care: evidence from the Australian Stroke Clinical Registry.
Austin Authors: Phan, Hoang T;Gall, Seana L;Blizzard, Christopher L;Lannin, Natasha A;Thrift, Amanda G;Anderson, Craig S;Kim, Joosup;Grimley, Rohan S;Castley, Helen C;Kilkenny, Monique F;Cadilhac, Dominique A
Affiliation: Menzies Institute for Medical Research Tasmania, University of Tasmania, Australia
Department of Public Health Management, Pham Ngoc Thach University of Medicine, Vietnam
Neurology Department, Royal Hobart Hospital, Hobart, Tasmania, Australia
School of Medicine, Griffith University, Birtinya, Queensland, Australia
Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
Alfred Health, Melbourne, Victoria, Australia
Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
The Florey Institute of Neuroscience and Mental Health
The George Institute for Global Health, Faculty of Medicine, The University of New South Wales, Sydney, Australia
Issue Date: Feb-2021
Date: 2020-10-15
Publication information: European Journal of Neurology 2021; 28(2): 469-478
Abstract: Women may receive stroke care less often than men. We examined the contribution of clinical care on sex differences and health-related quality of life (HRQoL) after stroke. We included first-ever strokes registered in the Australian Stroke Clinical Registry (2010-2014) with HRQoL assessed between 90-180 days after onset (EQ-5D-3L instrument) that were linked to hospital administrative data (up to 2013). Study factors included sociodemographics, comorbidities, walking ability on admission (stroke severity proxy) and clinical care (e.g. stroke unit care). Responses to the EQ-5D-3L were transformed into a total utility value (-0.516 'worse than death' to 1 'best' health). Quantile regression models, adjusted for confounding factors, were used to determine median differences (MD) in utility scores by sex. Approximately 60% (6,852/11,418) of stroke survivors had an EQ-5D-3L assessment (median 139 days; 44% female). Compared with men, women were older (median age 77.1 vs men 71.2) and fewer could walk on admission (37.9% vs men 46.1%, p<0.001). Women had lower utility values than men and the difference was explained by age and stroke severity, but not clinical care (MDadjusted -0.039, 95% CI -0.056, -0.021). Poorer HRQoL was observed in younger men (aged <65 years), particularly those with more comorbidities, and in older women (aged ≥75 years). Stroke severity and co-morbidities contribute to the poorer HRQoL in young men and older women. Further studies are needed to understand age-sex interaction to better inform treatments for different sub-groups and ensure evidence-based treatments to reduce the severity of stroke are prioritized.
DOI: 10.1111/ene.14531
ORCID: 0000-0003-0506-2924
Journal: European Journal of Neurology
PubMed URL: 32920917
Type: Journal Article
Subjects: cerebrovascular diseases
cohort study
neurological disorders
quality of life
sex difference
Appears in Collections:Journal articles

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