Predictors of functional outcome after stroke: Sex differences in older individuals

Anastasios Mavridis; Malin Reinholdsson; Katharina S Sunnerhagen; Tamar Abzhandadze

doi:10.1111/jgs.18963

Predictors of functional outcome after stroke: Sex differences in older individuals

J Am Geriatr Soc. 2024 May 13. doi: 10.1111/jgs.18963. Online ahead of print.

Authors

Anastasios Mavridis^{1

2}, Malin Reinholdsson^{2

3}, Katharina S Sunnerhagen^{2

4}, Tamar Abzhandadze^{2

3}

Affiliations

¹ School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece.
² Institute of Neuroscience and Physiology, Rehabilitation Medicine, University of Gothenburg, Gothenburg, Sweden.
³ Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden.
⁴ Neurocare, Sahlgrenska University Hospital, Gothenburg, Sweden.

PMID: 38741476
DOI: 10.1111/jgs.18963

Abstract

Background: Sex differences in stroke are well documented, with females being older at onset, with more severe strokes and worse outcomes than males. Females receive less comprehensive stroke unit treatment. Similarly, older individuals receive poorer quality care than younger ones. There is limited research on sex differences in factors that impact 3-month poststroke functional outcome in people older than 80 years.

Methods: This register-based and cross-sectional study analyzed data from two stroke quality registers in Sweden from 2014 through 2019. The study included patients aged ≥80 with a diagnosis of ischemic or hemorrhagic stroke. Sociodemographic features, prestroke condition, stroke severity on admission (National Institutes of Health Stroke Scale [NIHSS]), stroke unit care, rehabilitation plans, and 3-month poststroke functional outcome measured with the modified Rankin Scale were analyzed. Ordinal regression analyses stratified by sex were conducted to assess sex differences in factors that impact poststroke functional outcome 3 months after the stroke.

Results: A total of 2245 patients were studied with the majority (59.2%) being females. Females experienced more severe strokes (NIHSS median 4 vs. 3, p = 0.01) and were older at stroke onset than males (87.0 vs. 85.4, p < 0.001). Females were also less independent prestroke (69.9% vs. 77.4%, p < 0.001) and a higher proportion of females lived alone (78.2% vs. 44.2%, p < 0.001). Males received intravenous thrombolysis more often than females (16.3% vs. 12.0%, p = 0.005). Regarding 3-month functional outcome, males benefited more from thrombolysis (odds ratio [OR] 0.52, 95% confidence interval [CI] 0.30-0.83), whereas females benefited more from thrombectomy (OR 0.40, 95% CI 0.20-0.71).

Conclusion: Stroke care should be adapted to sex disparities in older individuals, while clinicians should be aware of these sex disparities. Further research could clarify the mechanisms behind these disparities and lead to a more personalized approach to stroke care of the older population.

Keywords: cerebral infarction; gender differences; rehabilitation; stroke care; treatment.

Abstract

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