Explaining poorer stroke outcomes in women: women surviving 3 months have more severe strokes than men despite a lower 3-month case fatality

TY - JOUR

T1 - Explaining poorer stroke outcomes in women

T2 - women surviving 3 months have more severe strokes than men despite a lower 3-month case fatality

AU - Olsen, Tom Skyhøj

AU - Andersen, Zorana Jovanovic

AU - Andersen, Klaus Kaae

N1 - Copyright © 2012 Elsevier HS Journals, Inc. All rights reserved.

PY - 2012/6

Y1 - 2012/6

N2 - Background: Women who survive stroke are more disabled and more often institutionalized than men. Objective: We explore this phenomenon by studying case fatality and stroke severity in stroke survivors separately for men and women. Methods: A Danish stroke registry (2000-2007) contains information about 26,818 patients with first-ever ischemic stroke, including stroke severity (Scandinavian Stroke Scale, 0 worst to 58 best), computed tomography scan, cardiovascular risk factors, and death 3 months after stroke. We modeled stroke severity by generalized additive linear model and 3-month case fatality with logistic model adjusting for age and cardiovascular risk factors. Results: Male to female ratio was 51.5% to 48.5%. Mean age was 68.8 (SD 12.6) years in men; 73.7 (13.8) years in women. Stroke was more severe in women (mean [SD] Scandinavian Stroke Scale, 42.2 [16.0]) than in men (mean [SD] Scandinavian Stroke Scale, 45.6 [14.2]) also after adjustment for age and cardiovascular risk factors; significant in patients older than 75 years. In survivors at 3 months, stroke was more severe in women than men, given same age and cardiovascular risk factor profile; significant in patients older than 75 years. More women (11.9%) had died within 3 months than men (8.6%). However, adjusting for age, stroke severity, and risk factor profile, 3-month case fatality was lower in women than men; significant in patients older than 78 years. Conclusions: Although 3-month case fatality was lower in women than men, strokes were more severe among survivors at 3 months in women than in men. In addition, strokes were more severe in women. Our data help elucidate why women survive stroke better but have poorer functional outcomes that require more care than men.

AB - Background: Women who survive stroke are more disabled and more often institutionalized than men. Objective: We explore this phenomenon by studying case fatality and stroke severity in stroke survivors separately for men and women. Methods: A Danish stroke registry (2000-2007) contains information about 26,818 patients with first-ever ischemic stroke, including stroke severity (Scandinavian Stroke Scale, 0 worst to 58 best), computed tomography scan, cardiovascular risk factors, and death 3 months after stroke. We modeled stroke severity by generalized additive linear model and 3-month case fatality with logistic model adjusting for age and cardiovascular risk factors. Results: Male to female ratio was 51.5% to 48.5%. Mean age was 68.8 (SD 12.6) years in men; 73.7 (13.8) years in women. Stroke was more severe in women (mean [SD] Scandinavian Stroke Scale, 42.2 [16.0]) than in men (mean [SD] Scandinavian Stroke Scale, 45.6 [14.2]) also after adjustment for age and cardiovascular risk factors; significant in patients older than 75 years. In survivors at 3 months, stroke was more severe in women than men, given same age and cardiovascular risk factor profile; significant in patients older than 75 years. More women (11.9%) had died within 3 months than men (8.6%). However, adjusting for age, stroke severity, and risk factor profile, 3-month case fatality was lower in women than men; significant in patients older than 78 years. Conclusions: Although 3-month case fatality was lower in women than men, strokes were more severe among survivors at 3 months in women than in men. In addition, strokes were more severe in women. Our data help elucidate why women survive stroke better but have poorer functional outcomes that require more care than men.

KW - Age Factors

KW - Aged

KW - Aged, 80 and over

KW - Cohort Studies

KW - Denmark

KW - Female

KW - Follow-Up Studies

KW - Humans

KW - Male

KW - Middle Aged

KW - Risk Factors

KW - Severity of Illness Index

KW - Sex Factors

KW - Stroke

KW - Survival Rate

KW - Survivors

U2 - 10.1016/j.genm.2012.03.002

DO - 10.1016/j.genm.2012.03.002

M3 - Journal article

C2 - 22498425

SN - 1550-8579

VL - 9

SP - 147

EP - 153

JO - Gender Medicine

JF - Gender Medicine

IS - 3

ER -