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Phan HT, Gall SL, Blizzard CL, Lannin NA, Thrift AG, Anderson CS, Kim J, Grimley R, Castley HC, Hand P, Cadilhac DA. Sex Differences in Care and Long-Term Mortality After Stroke: Australian Stroke Clinical Registry. J Womens Health (Larchmt) 2019; 28:712-720. [PMID: 30900954 DOI: 10.1089/jwh.2018.7171] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Introduction: There is some evidence that women receive evidence-based care less often than men, but how this influences long-term mortality after stroke is unclear. We explored this issue using data from a national stroke registry. Materials and Methods: Data are first-ever hospitalized strokes (2010-2014) in the Australian Stroke Clinical Registry from 39 hospitals linked to the national death registrations. Multilevel Poisson regression was used to estimate the women:men mortality rate ratio (MRR), with adjustment for sociodemographics, stroke severity, and processes of care (stroke unit care, intravenous thrombolysis, antihypertensive agent[s], and discharge care plan). Results: Among 14,118 events (46% females), women were 7 years older and had greater baseline severity compared to men (29% vs. 37%; p < 0.001), but there were no differences in the four processes of care available across hospitals. In the whole cohort, 1-year mortality was greater in women than men (MRRunadjusted 1.44, 95% confidence interval [CI] 1.34-1.54). However, there were no differences after adjusting for age and stroke severity (MRRadjusted 1.03, 95% CI 0.95-1.10). In analyses of additional processes from Queensland hospitals (n = 5224), women were less often administered aspirin ≤48 hours (61% vs. men 69%, p < 0.015). In Queensland hospitals, there were no statistically significant sex differences in 1-year mortality after adjusting for age, stroke severity, and early administration of aspirin. Conclusion: Greater mortality in women can be explained by differences in age and stroke severity. This highlights the importance of better management of risk factors in the elderly and, potentially, the need for greater access to early aspirin for women with stroke.
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Affiliation(s)
- Hoang T Phan
- 1 Menzies Institute for Medical Research Tasmania, University of Tasmania, Hobart, Australia.,2 Department of Public Health Management, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
| | - Seana L Gall
- 1 Menzies Institute for Medical Research Tasmania, University of Tasmania, Hobart, Australia
| | - Christopher L Blizzard
- 1 Menzies Institute for Medical Research Tasmania, University of Tasmania, Hobart, Australia
| | - Natasha A Lannin
- 3 School of Allied Health, College of Science, Health and Engineering, La Trobe University, Bundoora, Australia
| | - Amanda G Thrift
- 4 Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia
| | - Craig S Anderson
- 5 The George Institute for Global Health, Faculty of Medicine, UNSW, Sydney, Australia
| | - Joosup Kim
- 4 Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia
| | - Rohan Grimley
- 4 Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia.,6 Sunshine Coast Clinical School, University of Queensland, Birtinya, Australia
| | - Helen C Castley
- 7 Neurology Department, Royal Hobart Hospital, Hobart, Australia
| | - Peter Hand
- 8 Department of Neurology, Royal Melbourne Hospital, Melbourne, Australia
| | - Dominique A Cadilhac
- 4 Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia.,9 Stroke Division, Florey Institute Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia
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