Explaining Poorer Stroke Outcomes in Women: Women Surviving 3 Months Have More Severe Strokes Than Men Despite a Lower 3-Month Case Fatality

The Stroke Unit, Frederiksberg University Hospital, Frederiksberg, Denmark.
Gender Medicine (Impact Factor: 2.26). 04/2012; 9(3):147-53. DOI: 10.1016/j.genm.2012.03.002
Source: PubMed


Women who survive stroke are more disabled and more often institutionalized than men.
We explore this phenomenon by studying case fatality and stroke severity in stroke survivors separately for men and women.
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.
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.
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.

Download full-text


Available from: Zorana Jovanovic Andersen, Feb 04, 2015
  • [Show abstract] [Hide abstract]
    ABSTRACT: Aim: Reports on centenarians with stroke have thus far been casuistic. We present clinical characteristics and 1-month mortality in 39 centenarians admitted to Danish hospitals with acute stroke within 2000-2010. Methods: A Danish stroke registry (2000-2010) contains information about 61 935 acute stroke patients among which 39 patients were centenarians. Data included age, sex, civil and housing status, stroke severity (Scandinavian Stroke Scale [SSS], 0 worst to 58 best), computed tomography scan, cardiovascular risk factors and death within 1 month after stroke. Data in centenarians were compared with similar data in stroke patients aged 40-69 years (n = 25 023), 70-79 years (n = 16 048), 80-89 years (n = 16 274) and 90-99 years (n = 3379). Results: Of the 39 centenarians, 87% were women, 82% were living alone and 64% were living in their own home before the stroke. In general, the prevalence of cardiovascular risk factors was lower in centenarians, particularly with regard to previous myocardial infarction, previous stroke and diabetes mellitus. Strokes were significantly more severe (SSS 25.4), and 1-month mortality (38.5%) was significantly higher in centenarians when compared with other age groups. Conclusion: Centenarians with stroke are from a cardiovascular standpoint healthier than their younger counterparts. Yet, strokes in centenarians are more severe and associated with very high mortality.
    Geriatrics & Gerontology International 03/2013; 14(1). DOI:10.1111/ggi.12058 · 2.19 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Stroke outcome has been reported as worse in women, especially in terms of disability. As for mortality, the data are conflicting, with some reports suggesting a female advantage. Our objective was to explore such issues in an Italian cohort of patients managed by a standardized clinical pathway (CPW) and, as such, homogeneous in terms of clinical management. Data from a cohort of 1993 patients (987 women and 1006 men) with first-ever ischemic stroke, consecutively referred to an in-hospital Clinical Pathway Program from January 1, 2001 to December 31, 2009, were retrospectively analyzed. The relationship between female gender and one-month outcome was assessed with adjustment for age, stroke severity and premorbid disability. The outcome was worse in women in terms of disability (age-adjusted odds ratio 2.03, 95% CI 1.69-2.46), while no difference was found for mortality. In multivariate models, female gender turned out to be associated with a lower case-fatality rate (adjusted hazard ratio 0.65, 95% CI 0.48-0.89, P=0.007), whereas the odds ratio for disability decreased but remained significant (OR 1.30; 95% CI 1.01-1.69). We found a significant interaction between gender and age in the case-fatality rate, and a female survival advantage was apparent only below 50years. Our study confirms the excess risk of disability after stroke in women, although it is mostly explained by the occurrence of the most severe clinical syndromes. As for mortality, female gender seems to play a protective role, at least in the short-term and in younger patients.
    European Journal of Internal Medicine 08/2013; 24(8). DOI:10.1016/j.ejim.2013.07.015 · 2.89 Impact Factor

  • International Journal of Stroke 10/2014; 9:22-22. · 3.83 Impact Factor
Show more