Sex differences in treatment and outcome after stroke: Pooled analysis including 19,000 participants

Cheryl Carcel¹, Xia Wang², Else Charlotte Sandset², Candice Delcourt², Hisatomi Arima², Richard Lindley², Maree L Hackett², Pablo Lavados², Thompson G Robinson², Paula Muñoz Venturelli², Verónica V Olavarría², Alejandro Brunser², Eivind Berge², John Chalmers², Mark Woodward², Craig S Anderson²

Affiliations

¹ From The George Institute for Global Health (C.C., X.W., C.D., M.L.H., P.M.V., J.C., M.W., C.S.A.), University of New South Wales, Sydney; Sydney School of Public Health, Sydney Medical School (C.C., X.W., C.D., M.L.H., C.S.A.), The University of Sydney, New South Wales, Australia; Departments of Neurology (E.C.S.) and Internal Medicine (E.B.), Oslo University Hospital; Department of Research and Development (E.C.S.), The Norwegian Air Ambulance Foundation, Oslo, Norway; Department of Neurology (C.D.), Royal Prince Alfred Hospital, Sydney, Australia; Department of Public Health (H.A.), Fukuoka University, Japan; The George Institute for Global Health and Westmead Clinical School (R.L.), University of Sydney, Australia; Faculty of Health and Wellbeing (M.L.H.), The University of Central Lancashire, Preston, UK; Unidad de Neurología Vascular (P.L., P.M.V., V.V.O., A.B.), Servicio de Neurología, Departamento de Neurología y Psiquiatría, Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago; Departamento de Ciencias Neurológicas (P.L.), Facultad de Medicina, Universidad de Chile; Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Centre (T.G.R.), University of Leicester, UK; Centro de Estudios Clínicos (P.M.V.), Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago; Departamento de Paciente Crítico (V.V.O.), Clínica Alemana de Santiago, Chile; The George Institute for Global Health (M.W.), University of Oxford, UK; Department of Epidemiology (M.W.), Johns Hopkins University, Baltimore, MD; and The George Institute China at Peking University Health Science Centre (C.S.A.), Beijing, China. ccarcel@georgeinstitute.org.au.
² From The George Institute for Global Health (C.C., X.W., C.D., M.L.H., P.M.V., J.C., M.W., C.S.A.), University of New South Wales, Sydney; Sydney School of Public Health, Sydney Medical School (C.C., X.W., C.D., M.L.H., C.S.A.), The University of Sydney, New South Wales, Australia; Departments of Neurology (E.C.S.) and Internal Medicine (E.B.), Oslo University Hospital; Department of Research and Development (E.C.S.), The Norwegian Air Ambulance Foundation, Oslo, Norway; Department of Neurology (C.D.), Royal Prince Alfred Hospital, Sydney, Australia; Department of Public Health (H.A.), Fukuoka University, Japan; The George Institute for Global Health and Westmead Clinical School (R.L.), University of Sydney, Australia; Faculty of Health and Wellbeing (M.L.H.), The University of Central Lancashire, Preston, UK; Unidad de Neurología Vascular (P.L., P.M.V., V.V.O., A.B.), Servicio de Neurología, Departamento de Neurología y Psiquiatría, Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago; Departamento de Ciencias Neurológicas (P.L.), Facultad de Medicina, Universidad de Chile; Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Centre (T.G.R.), University of Leicester, UK; Centro de Estudios Clínicos (P.M.V.), Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago; Departamento de Paciente Crítico (V.V.O.), Clínica Alemana de Santiago, Chile; The George Institute for Global Health (M.W.), University of Oxford, UK; Department of Epidemiology (M.W.), Johns Hopkins University, Baltimore, MD; and The George Institute China at Peking University Health Science Centre (C.S.A.), Beijing, China.

PMID: 31719135
DOI: 10.1212/WNL.0000000000008615

Sex differences in treatment and outcome after stroke: Pooled analysis including 19,000 participants

Cheryl Carcel et al. Neurology. 2019.

. 2019 Dec 10;93(24):e2170-e2180.

doi: 10.1212/WNL.0000000000008615. Epub 2019 Nov 12.

Authors

Affiliations

¹ From The George Institute for Global Health (C.C., X.W., C.D., M.L.H., P.M.V., J.C., M.W., C.S.A.), University of New South Wales, Sydney; Sydney School of Public Health, Sydney Medical School (C.C., X.W., C.D., M.L.H., C.S.A.), The University of Sydney, New South Wales, Australia; Departments of Neurology (E.C.S.) and Internal Medicine (E.B.), Oslo University Hospital; Department of Research and Development (E.C.S.), The Norwegian Air Ambulance Foundation, Oslo, Norway; Department of Neurology (C.D.), Royal Prince Alfred Hospital, Sydney, Australia; Department of Public Health (H.A.), Fukuoka University, Japan; The George Institute for Global Health and Westmead Clinical School (R.L.), University of Sydney, Australia; Faculty of Health and Wellbeing (M.L.H.), The University of Central Lancashire, Preston, UK; Unidad de Neurología Vascular (P.L., P.M.V., V.V.O., A.B.), Servicio de Neurología, Departamento de Neurología y Psiquiatría, Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago; Departamento de Ciencias Neurológicas (P.L.), Facultad de Medicina, Universidad de Chile; Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Centre (T.G.R.), University of Leicester, UK; Centro de Estudios Clínicos (P.M.V.), Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago; Departamento de Paciente Crítico (V.V.O.), Clínica Alemana de Santiago, Chile; The George Institute for Global Health (M.W.), University of Oxford, UK; Department of Epidemiology (M.W.), Johns Hopkins University, Baltimore, MD; and The George Institute China at Peking University Health Science Centre (C.S.A.), Beijing, China. ccarcel@georgeinstitute.org.au.
² From The George Institute for Global Health (C.C., X.W., C.D., M.L.H., P.M.V., J.C., M.W., C.S.A.), University of New South Wales, Sydney; Sydney School of Public Health, Sydney Medical School (C.C., X.W., C.D., M.L.H., C.S.A.), The University of Sydney, New South Wales, Australia; Departments of Neurology (E.C.S.) and Internal Medicine (E.B.), Oslo University Hospital; Department of Research and Development (E.C.S.), The Norwegian Air Ambulance Foundation, Oslo, Norway; Department of Neurology (C.D.), Royal Prince Alfred Hospital, Sydney, Australia; Department of Public Health (H.A.), Fukuoka University, Japan; The George Institute for Global Health and Westmead Clinical School (R.L.), University of Sydney, Australia; Faculty of Health and Wellbeing (M.L.H.), The University of Central Lancashire, Preston, UK; Unidad de Neurología Vascular (P.L., P.M.V., V.V.O., A.B.), Servicio de Neurología, Departamento de Neurología y Psiquiatría, Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago; Departamento de Ciencias Neurológicas (P.L.), Facultad de Medicina, Universidad de Chile; Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Centre (T.G.R.), University of Leicester, UK; Centro de Estudios Clínicos (P.M.V.), Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago; Departamento de Paciente Crítico (V.V.O.), Clínica Alemana de Santiago, Chile; The George Institute for Global Health (M.W.), University of Oxford, UK; Department of Epidemiology (M.W.), Johns Hopkins University, Baltimore, MD; and The George Institute China at Peking University Health Science Centre (C.S.A.), Beijing, China.

PMID: 31719135
DOI: 10.1212/WNL.0000000000008615

Erratum in

Sex Differences in Treatment and Outcome After Stroke: Pooled Analysis Including 19,000 Participants.
[No authors listed] [No authors listed] Neurology. 2021 Jun 8;96(23):1106. doi: 10.1212/WNL.0000000000011946. Neurology. 2021. PMID: 34099537 No abstract available.

Abstract

Objective: To explore the sex differences in outcomes and management after stroke using a large sample with high-quality international trial data.

Methods: Individual participant data were obtained from 5 acute stroke randomized controlled trials. Data were obtained on demographics, medication use, in-hospital treatment, and functional outcome. Study-specific crude and adjusted models were used to estimate sex differences in outcomes and management, and then pooled using random-effects meta-analysis.

Results: There were 19,652 participants, of whom 7,721 (40%) were women. After multivariable adjustments, women with ischemic stroke had higher survival at 3-6 months (odds ratio [OR] 0.82, 95% confidence interval [CI] 0.70-0.97), higher likelihood of disability (OR 1.20, 95% CI 1.06-1.36), and worse quality of life (weighted mean difference -0.07, 95% CI -0.09 to 0.04). For management, women were more likely to be admitted to an acute stroke unit (OR 1.17, 95% CI 1.01-1.34), but less likely to be intubated (OR 0.58, 95% CI 0.36-0.93), treated for fever (OR 0.82, 95% CI 0.70-0.95), or admitted to an intensive care unit (OR 0.83, 95% CI 0.74-0.93). For preadmission medications, women had higher odds of being prescribed antihypertensive agents (OR 1.22, 95% CI 1.13-1.31) and lower odds of being prescribed antiplatelets (OR 0.86, 95% CI 0.79-0.93), glucose-lowering agents (OR 0.86, 95% CI 0.78-0.94), or lipid-lowering agents (OR 0.85, 95% CI 0.77-0.94).

Conclusions: This analysis suggests that women who had ischemic stroke had better survival but were also more disabled and had poorer quality of life. Variations in hospital and out-of-hospital management may partly explain the disparities.

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Comment in

Sex differences in the use of therapeutic resources and stroke outcomes in 5 randomized trials.
Sposato LA, Brown DL. Sposato LA, et al. Neurology. 2019 Dec 10;93(24):1025-1027. doi: 10.1212/WNL.0000000000008610. Epub 2019 Nov 12. Neurology. 2019. PMID: 31719138 No abstract available.
Reader response: Sex differences in treatment and outcome after stroke: Pooled analysis including 19,000 participants.
Ganesh A, Varma M. Ganesh A, et al. Neurology. 2020 Nov 24;95(21):986-987. doi: 10.1212/WNL.0000000000011041. Neurology. 2020. PMID: 33229497 No abstract available.
Author response: Sex differences in treatment and outcome after stroke: Pooled analysis including 19,000 participants.
Carcel C, Woodward M. Carcel C, et al. Neurology. 2020 Nov 24;95(21):987. doi: 10.1212/WNL.0000000000011042. Neurology. 2020. PMID: 33229498 No abstract available.

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Sex differences in treatment and outcome after stroke: Pooled analysis including 19,000 participants

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Sex differences in treatment and outcome after stroke: Pooled analysis including 19,000 participants

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