J Neurocrit Care.  2019 Dec;12(2):92-97. 10.18700/jnc.190108.

Sex disparity in acute ischemic stroke outcomes in Korea

Affiliations
  • 1Department of Neurology, Dong-A University Hospital, Busan, Republic of Korea. nrcjk65@gmail.comed
  • 2Stroke Center, Dong-A University Hospital, Busan, Republic of Korea.
  • 3Department of Intensive Care Medicine, Dong-A University Hospital, Busan, Republic of Korea.

Abstract

BACKGROUND
It is unclear whether women diagnosed with acute ischemic stroke (AIS) have worse outcome after adjusting for several confounding factors such as age, initial stroke severity, and risk factors. In this study, we investigated sex disparities in long-term functional outcome after AIS.
METHODS
We recruited patients with AIS prospectively registered in the Clinical Research Collaboration for Stroke in Korea database of Dong-A University Stroke Center between 2015 and 2018. We reviewed the patients' clinical demographics, living type (alone or cohabitating), laboratory and radiological findings, stroke severity, stroke subtype, and cardiovascular risk profile. We compared the long-term functional outcomes between men and women using the modified Rankin Scale score at 90 days and 1 year after AIS.
RESULTS
A total of 2,711 patients with AIS were enrolled in this study. Women comprised 38.9% (1,055) of all participants. Compared with men, women were significantly older (72.7±11.6 vs.65.6±12.2, P<0.01), showed more severe neurologic deficits (median National Institutes of Health Stroke Scale, 5 vs. 4, P<0.01), and had a higher rate of living alone (57.1% vs. 42.9%, P<0.01) and a higher prevalence of poor functional outcome at 90 days and 1 year after AIS. However, differences in history of statin use, hospital arrival time, and thrombolysis between the two sexes were not observed. After adjusting for several confounding factors, differences in initial neurologic deficits or long-term functional outcomes between sexes were not observed.
CONCLUSION
This study demonstrated the absence of sex disparities in the status of medical attention for thrombolysis.

Keyword

Stroke; Sex; Marital status; Treatment outcome

MeSH Terms

Cooperative Behavior
Demography
Female
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Korea*
Male
Marital Status
National Institutes of Health (U.S.)
Neurologic Manifestations
Prevalence
Prospective Studies
Risk Factors
Stroke*
Treatment Outcome

Figure

  • Fig. 1. Distribution of poor functional outcome at 90 days after the diagnosis of acute ischemic stroke by age and sex in the total population. Poor functional outcome (modified Rankin Scale [mRS] score >2). Any significant difference in poor functional outcome after acute ischemic stroke between both sexes in 80 years or older population (odds ratio, 1.39; 95% confidence interval, 0.84 to 2.29; P=0.20) (Supplementary Table 3) after adjusting for age, National Institutes of Health Stroke Scale score, living type, hospital arrival time, mechanical thrombectomy, previous history of statin use, previous history of atrial fibrillation, previous history of coronary artery disease, and stroke subtypes.


Reference

1. National Center for Health Statistics. Health, United States, 2004 with chartbook on trends in the health of Americans. Hyattsville: US Government Printing Office;2004.
2. Adamson J, Beswick A, Ebrahim S. Is stroke the most common cause of disability? J Stroke Cerebrovasc Dis. 2004; 13:171–7.
Article
3. Hong KS, Bang OY, Kang DW, Yu KH, Bae HJ, Lee JS, et al. Stroke statistics in Korea: part I. Epidemiology and risk factors: a report from the Korean Stroke Society and clinical research center for stroke. J Stroke. 2013; 15:2–20.
Article
4. Kim JS, Lee KB, Roh H, Ahn MY, Hwang HW. Gender differences in the functional recovery after acute stroke. J Clin Neurol. 2010; 6:183–8.
Article
5. Maeda K, Toyoda K, Minematsu K, Kobayashi S; Japan Standard Stroke Registry Study Group. Effects of sex difference on clinical features of acute ischemic stroke in Japan. J Stroke Cerebrovasc Dis. 2013; 22:1070–5.
Article
6. Di Carlo A, Lamassa M, Baldereschi M, Pracucci G, Basile AM, Wolfe CD, et al. Sex differences in the clinical presentation, resource use, and 3-month outcome of acute stroke in Europe: data from a multicenter multinational hospital-based registry. Stroke. 2003; 34:1114–9.
7. Gall SL, Donnan G, Dewey HM, Macdonell R, Sturm J, Gilligan A, et al. Sex differences in presentation, severity, and management of stroke in a population-based study. Neurology. 2010; 74:975–81.
Article
8. Holroyd-Leduc JM, Kapral MK, Austin PC, Tu JV. Sex differences and similarities in the management and outcome of stroke patients. Stroke. 2000; 31:1833–7.
Article
9. Roquer J, Campello AR, Gomis M. Sex differences in first-ever acute stroke. Stroke. 2003; 34:1581–5.
Article
10. Messé SR, Khatri P, Reeves MJ, Smith EE, Saver JL, Bhatt DL, et al. Why are acute ischemic stroke patients not receiving IV tPA? Results from a national registry. Neurology. 2016; 87:1565–74.
11. Reid JM, Dai D, Gubitz GJ, Kapral MK, Christian C, Phillips SJ. Gender differences in stroke examined in a 10-year cohort of patients admitted to a Canadian teaching hospital. Stroke. 2008; 39:1090–5.
Article
12. Foerch C, Misselwitz B, Humpich M, Steinmetz H, Neumann-Haefelin T, Sitzer M, et al. Sex disparity in the access of elderly patients to acute stroke care. Stroke. 2007; 38:2123–6.
Article
13. Kapral MK, Fang J, Hill MD, Silver F, Richards J, Jaigobin C, et al. Sex differences in stroke care and outcomes: results from the Registry of the Canadian Stroke Network. Stroke. 2005; 36:809–14.
14. Kelly-Hayes M, Beiser A, Kase CS, Scaramucci A, D'Agostino RB, Wolf PA. The influence of gender and age on disability following ischemic stroke: the Framingham study. J Stroke Cerebrovasc Dis. 2003; 12:119–26.
Article
15. Lai SM, Duncan PW, Dew P, Keighley J. Sex differences in stroke recovery. Prev Chronic Dis. 2005; 2:A13.
16. Lee KJ, Kim BJ, Kim DE, Ryu WS, Han MK, Kim JT, et al. Nationwide estimation of eligibility for endovascular thrombectomy based on the DAWN trial. J Stroke. 2018; 20:277–9.
Article
17. Adams HP Jr, Bendixen BH, Kappelle LJ, Biller J, Love BB, Gordon DL, et al. Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke. 1993; 24:35–41.
Article
18. Simpson CR, Wilson C, Hannaford PC, Williams D. Evidence for age and sex differences in the secondary prevention of stroke in Scottish primary care. Stroke. 2005; 36:1771–5.
Article
19. Glader EL, Stegmayr B, Norrving B, Terént A, Hulter-Asberg K, Wester PO, et al. Sex differences in management and outcome after stroke: a Swedish national perspective. Stroke. 2003; 34:1970–5.
20. Reeves MJ, Prager M, Fang J, Stamplecoski M, Kapral MK. Impact of living alone on the care and outcomes of patients with acute stroke. Stroke. 2014; 45:3083–5.
Article
21. Redfors P, Isaksén D, Lappas G, Blomstrand C, Rosengren A, Jood K, et al. Living alone predicts mortality in patients with ischemic stroke before 70 years of age: a long-term prospective follow-up study. BMC Neurol. 2016; 16:80.
Article
22. Kristofferzon ML, Löfmark R, Carlsson M. Myocardial infarction: gender differences in coping and social support. J Adv Nurs. 2003; 44:360–74.
Article
23. Hanna KL, Collins PF. Relationship between living alone and food and nutrient intake. Nutr Rev. 2015; 73:594–611.
Article
24. McCullough LD, Hurn PD. Estrogen and ischemic neuroprotection: an integrated view. Trends Endocrinol Metab. 2003; 14:228–35.
Article
25. Bushnell CD, Hurn P, Colton C, Miller VM, del Zoppo G, Elkind MS, et al. Advancing the study of stroke in women: summary and recommendations for future research from an NINDS-Sponsored Multidisciplinary Working Group. Stroke. 2006; 37:2387–99.
26. Son HC. The Confucian understanding of women. Cathol Philos. 2005; 7:109–47.
27. Statics Korea. Press releases: employment and labour [Internet]. Daejeon (KR): Statics Korea;c1996-2019. [cited 2019 Dec 16]. Available from: http://kostat.go.kr/portal/eng/pressReleases/5/1/index.board.
Full Text Links
  • JNC
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2022 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr