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

• Type: Article in International Scientific Journal
• Date: 2018

Authors

Phan, HT (Author) Other; Blizzard, CL (Author) Other; Reeves, MJ (Author) Other; Thrift, AG (Author) Other; Cadilhac, DA (Author) Other; Sturm, J (Author) Other; Heeley, E (Author) Other; Otahal, P (Author) Other; Vemmos, K (Author) Other; Anderson, C (Author) Other; Parmar, P (Author) Other; Krishnamurthi, R (Author) Other; Barker Collo, S (Author) Other; Feigin, V (Author) Other; Bejot, Y (Author) Other; Cabral, NL (Author) Other; Carolei, A (Author) Other; Sacco, S (Author) Other; Chausson, N (Author) Other; Olindo, S (Author) Other; Rothwell, P (Author) Other; silva, mc (Author) Other; Correia, M (Author) Other; Magalhaes, R (Author) ICBAS; Appelros, P (Author) Other; Korv, J (Author) Other; Vibo, R (Author) Other; Minelli, C (Author) Other; Gall, SL (Author) Other

Journal

Title: Neurology

Vol. 90

ISSN: 0028-3878

Publisher: Wolters Kluwer Health

Indexing

ISI Web of Knowledge - 44 Citations

Scopus - 47 Citations

Other information

Authenticus ID: P-00P-2RG

DOI: 10.1212/wnl.0000000000005602

Abstract (EN): 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 logbinomial 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: RRunadjusted 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: RRadjusted 1.08, 95% CI 0.97-1.20; 5 years: RRadjusted 1.05, 95% CI 0.94-1.18). Women also had greater participation restriction than men (pooled MDunadjusted -5.55, 95% CI -8.47 to -2.63), but this difference was again attenuated after adjustment for the aforementioned factors (MDadjusted -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.

Language: English

Type (Professor's evaluation): Scientific

No. of pages: 9