Factors contributing to sex differences in functional outcomes and participation after stroke

Hoang T Phan; Christopher L Blizzard; Mathew J Reeves; Amanda G Thrift; Dominique A Cadilhac; Jonathan Sturm; Emma Heeley; Petr Otahal; Konstantinos Vemmos; Craig Anderson; Priya Parmar; Rita Krishnamurthi; Suzanne Barker-Collo; Valery Feigin; Yannick Bejot; Norberto Luiz Cabral; Antonio Carolei; Simona Sacco; Nicolas Chausson; Stephane Olindo; Peter Rothwell; Carolina Silva; Manuel Correia; Rui Magalhães; Peter Appelros; Janika Kõrv; Riina Vibo; Cesar Minelli; Seana L Gall

doi:10.1212/WNL.0000000000005602

Factors contributing to sex differences in functional outcomes and participation after stroke

Neurology. 2018 May 29;90(22):e1945-e1953. doi: 10.1212/WNL.0000000000005602. Epub 2018 Apr 27.

Authors

Hoang T Phan¹, Christopher L Blizzard¹, Mathew J Reeves¹, Amanda G Thrift¹, Dominique A Cadilhac¹, Jonathan Sturm¹, Emma Heeley¹, Petr Otahal¹, Konstantinos Vemmos¹, Craig Anderson¹, Priya Parmar¹, Rita Krishnamurthi¹, Suzanne Barker-Collo¹, Valery Feigin¹, Yannick Bejot¹, Norberto Luiz Cabral¹, Antonio Carolei¹, Simona Sacco¹, Nicolas Chausson¹, Stephane Olindo¹, Peter Rothwell¹, Carolina Silva¹, Manuel Correia¹, Rui Magalhães¹, Peter Appelros¹, Janika Kõrv¹, Riina Vibo¹, Cesar Minelli¹, Seana L Gall²

Affiliations

¹ From the Menzies Institute for Medical Research Tasmania (H.T.P., C.L.B., P.O., S.L.G.), University of Tasmania, Hobart, Australia; Department of Health Management and Health Economics (H.T.P.), Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam; Department of Epidemiology and Biostatistics (M.J.R.), Michigan State University, East Lansing; Department of Medicine (A.G.T., D.A.C.), School of Clinical Sciences at Monash Health, Monash University, Clayton; Florey Institute Neuroscience and Mental Health (D.A.C.), Heidelberg, University of Melbourne, Victoria; Faculty of Health and Medicine (J.S.), University of Newcastle; George Institute for Global Health (E.H., C.A.), University of Sydney, New South Wales, Australia; Hellenic Cardiovascular Research Society (K.V.), Athens, Greece; National Institute for Stroke and Applied Neurosciences (P.P., R.K., V.F.), School of Public Health and Psychosocial Studies, Auckland University of Technology; School of Psychology (S.B.-C.), University of Auckland, New Zealand; University of Burgundy (Y.B.), University Hospital of Dijon, France; Clinica Neurológica de Joinville (N.L.C.), Joinville Stroke Registry, University of Joinville Region, Brazil; Department of Biotechnological and Applied Clinical Sciences (A.C., S.S.), Neurological Institute, University of L'Aquila, Italy; Stroke Unit (N.C.), Centre Hospitalier Sud Francilien, Corbeil-Essonnes; Stroke Unit (S.O.), University Hospital of Bordeaux, France; Stroke Prevention Research Unit (P.R.), Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK; UNIFAI (C.S., M.C., R.M.), Instituto de Ciências Biomédicas de Abel Salazar, Universidade do Porto, Portugal; Department of Neurology (P.A.), Faculty of Medicine and Health, Örebro University, Sweden; Department of Neurology and Neurosurgery (J.K., R.V.), University of Tartu, Estonia; and Hospital Carlos Fernando Malzoni and Neurologic Center of Research and Rehabilitation (C.M.), Matão, SP, Brazil.
² From the Menzies Institute for Medical Research Tasmania (H.T.P., C.L.B., P.O., S.L.G.), University of Tasmania, Hobart, Australia; Department of Health Management and Health Economics (H.T.P.), Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam; Department of Epidemiology and Biostatistics (M.J.R.), Michigan State University, East Lansing; Department of Medicine (A.G.T., D.A.C.), School of Clinical Sciences at Monash Health, Monash University, Clayton; Florey Institute Neuroscience and Mental Health (D.A.C.), Heidelberg, University of Melbourne, Victoria; Faculty of Health and Medicine (J.S.), University of Newcastle; George Institute for Global Health (E.H., C.A.), University of Sydney, New South Wales, Australia; Hellenic Cardiovascular Research Society (K.V.), Athens, Greece; National Institute for Stroke and Applied Neurosciences (P.P., R.K., V.F.), School of Public Health and Psychosocial Studies, Auckland University of Technology; School of Psychology (S.B.-C.), University of Auckland, New Zealand; University of Burgundy (Y.B.), University Hospital of Dijon, France; Clinica Neurológica de Joinville (N.L.C.), Joinville Stroke Registry, University of Joinville Region, Brazil; Department of Biotechnological and Applied Clinical Sciences (A.C., S.S.), Neurological Institute, University of L'Aquila, Italy; Stroke Unit (N.C.), Centre Hospitalier Sud Francilien, Corbeil-Essonnes; Stroke Unit (S.O.), University Hospital of Bordeaux, France; Stroke Prevention Research Unit (P.R.), Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK; UNIFAI (C.S., M.C., R.M.), Instituto de Ciências Biomédicas de Abel Salazar, Universidade do Porto, Portugal; Department of Neurology (P.A.), Faculty of Medicine and Health, Örebro University, Sweden; Department of Neurology and Neurosurgery (J.K., R.V.), University of Tartu, Estonia; and Hospital Carlos Fernando Malzoni and Neurologic Center of Research and Rehabilitation (C.M.), Matão, SP, Brazil. Seana.Gall@utas.edu.au.

PMID: 29703773
DOI: 10.1212/WNL.0000000000005602

Abstract

Objective: To examine factors contributing to the sex differences in functional outcomes and participation restriction after stroke.

Methods: 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.

Results: In unadjusted analyses, women experienced worse functional outcomes after stroke than men (1 year: pooled RR_unadjusted 1.32, 95% confidence interval [CI] 1.18-1.48; 5 years: RR_unadjusted 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: RR_adjusted 1.08, 95% CI 0.97-1.20; 5 years: RR_adjusted 1.05, 95% CI 0.94-1.18). Women also had greater participation restriction than men (pooled MD_unadjusted -5.55, 95% CI -8.47 to -2.63), but this difference was again attenuated after adjustment for the aforementioned factors (MD_adjusted -2.48, 95% CI -4.99 to 0.03).

Conclusions: 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.

Publication types

Editorial
Research Support, Non-U.S. Gov't

MeSH terms

Female
Humans
Male
Recovery of Function*
Risk Factors
Sex Factors
Stroke Rehabilitation*