Sex differences in stroke: epidemiology, clinical presentation, medical care, and outcomes

Abstract

Stroke has a greater effect on women than men because women have more events and are less likely to recover. Age-specific stroke rates are higher in men, but, because of their longer life expectancy and much higher incidence at older ages, women have more stroke events than men. With the exception of subarachnoid haemorrhage, there is little evidence of sex differences in stroke subtype or severity. Although several reports found that women are less likely to receive some in-hospital interventions, most differences disappear after age and comorbidities are accounted for. However, sex disparities persist in the use of thrombolytic treatment (with alteplase) and lipid testing. Functional outcomes and quality of life after stroke are consistently poorer in women, despite adjustment for baseline differences in age, prestroke function, and comorbidities. Here, we comprehensively review the epidemiology, clinical presentation, medical care, and outcomes of stroke in women.

Figure 1. Female:male mortality ratios for stroke by age (USA, 1999–2003)

Data from the US Centers for Disease Control and Prevention WONDER database.

Figure 2. Projected number of deaths from stroke among whites (USA, 2000–2050)

Age-specific and sex-specific mortality estimates were obtained from the US Centers for Disease Control and Prevention WONDER database, and age-specific and sex-specific population projections from the US Census Bureau middle series. Projected deaths were calculated by applying age-specific and sex-specific mortality data to the population projections.

Figure 3. Female:male incidence ratios for stroke by age

Data from the Greater Cincinnati–Northern Kentucky Stroke Study.

Figure 4. Female:male prevalence ratios for stroke by age

Unpublished data from the REGARDS study (personal communication by GH).