Sex differences in quality of life after ischemic stroke

Abstract

Objective: We aimed to compare quality of life (QOL) in women and men after ischemic stroke or TIA, and to determine the incremental impact of demographic, socioeconomic, clinical, and stroke-specific effects on longitudinal QOL.

Methods: We assessed QOL in patients with ischemic stroke or TIA at 3 and 12 months postdischarge in the Adherence eValuation After Ischemic stroke-Longitudinal Registry using the European Quality of Life-5 Dimensions (EQ-5D) instrument. We generated multivariable linear regression models to evaluate the association between sex and EQ-5D while sequentially adjusting for sociodemographic, clinical, and stroke-related variables. We also used a proportional odds model to assess sex differences in the change in EQ-5D scores from 3 to 12 months.

Results: A total of 1,370 patients were included, 53.7% male, median age 65 years (interquartile range 56-77 years). Women had significantly lower QOL at 3 months (unadjusted EQ-5D 0.81 in women vs 0.84 in men; p < 0.001) and 12 months (0.83 vs men 0.84; p < 0.001) poststroke. After multivariable adjustment for sociodemographic, clinical, and stroke-related factors, women continued to have lower QOL at 3 months (mean difference -0.036; p = 0.003) and at 12 months (mean difference -0.022; p = 0.046). Women fared worse in the dimensions of mobility, pain/discomfort, and anxiety/depression at 3 and 12 months. There were no sex differences in change in EQ-5D score from 3 to 12 months.

Conclusion: Women have worse QOL than men up to 12 months after stroke, even after adjusting for important sociodemographic variables, stroke severity, and disability.

Figure 1. Flow diagram of enrollment, follow-up, and analysis for AVAIL subjects

AVAIL = Adherence eValuation After Ischemic stroke–Longitudinal; EQ-5D = European Quality of Life–5 Dimensions; GWTG–Stroke = Get With The Guidelines–Stroke; NIHSS = NIH Stroke Scale.

Figure 2. EQ-5D and the proportion with no problems for each dimension in men and women

(A) 3 months. (B) 12 months. EQ-5D = European Quality of Life–5 Dimensions. *p < 0.007.

Figure 3. Mean difference (women to men) in multivariable models of EQ-5D

(A) 3-month models. Model 2: sex, age, race, marital status; model 3: model 2 plus education, baseline living and work status,* adequate income,* and insurance; model 4: model 3 plus stroke vs TIA, number of risk factors, number of medications prescribed at discharge,* and NIHSS score.* *p < 0.007 in model 4. (B) 12-month models. Model 2: Sex,† age, race, marital status; model 3: model 2 plus education, baseline living and work status,* adequate income, and insurance; model 4: model 3 plus stroke vs TIA, number of risk factors, number of medications prescribed at discharge,* and NIHSS score.* Model 5: model 4 plus 3-month living and work status; adequate income unchanged baseline to 3 months*; recurrent stroke,* modified Rankin Scale score ≥3,* had rehabilitation,* and medication persistence, all at 3 months.* †p = 0.046, and *p < 0.008 in model 5. EQ-5D = European Quality of Life–5 Dimensions; NIHSS = NIH Stroke Scale.