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. 2020 Mar 3;9(5):e015625.
doi: 10.1161/JAHA.119.015625. Epub 2020 Feb 28.

Differences in Diagnostic Evaluation in Women and Men After Acute Ischemic Stroke

Samuel S Bruce  1 , Alexander E Merkler  1 , Meenakshi Bassi  1 , Monica L Chen  1 , Setareh Salehi Omran  1   2 , Babak B Navi  1 , Hooman Kamel  1
Affiliations

Differences in Diagnostic Evaluation in Women and Men After Acute Ischemic Stroke

Samuel S Bruce et al. J Am Heart Assoc. .

Abstract

Background Sex differences have been found in stroke risk factors, incidence, treatment, and outcomes. There are conflicting data on whether diagnostic evaluation for stroke may differ between men and women. Methods and Results We performed a retrospective cohort study using inpatient and outpatient claims between 2008 and 2016 from a nationally representative 5% sample of Medicare beneficiaries. We included patients ≥65 years old and hospitalized with ischemic stroke, defined by International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) and ICD-10-CM diagnosis codes. Logistic regression was used to determine the association between female sex and the odds of diagnostic testing and specialist evaluation, adjusted for age, race, and number of Charlson comorbidities. Among 78 822 patients with acute ischemic stroke, 58.3% (95% CI, 57.9-58.6%) were women. Female sex was associated with decreased odds of intracranial vessel imaging (odds ratio [OR]: 0.94; 95% CI, 0.91-0.97), extracranial vessel imaging (OR: 0.89; 95% CI, 0.86-0.92), heart-rhythm monitoring (OR: 0.92; 95% CI, 0.87-0.98), echocardiography (OR: 0.92; 95% CI, 0.89-0.95), evaluation by a neurologist (OR: 0.94; 95% CI, 0.91-0.97), and evaluation by a vascular neurologist (OR: 0.94; 95% CI, 0.90-0.97), after adjustment for age, race, and comorbidities. These findings were unchanged in separate sensitivity analyses excluding patients who died during the index hospitalization or were discharged to hospice and excluding patients with atrial fibrillation diagnosed before their index stroke. Conclusions In a nationally representative cohort of Medicare beneficiaries, we found that women with acute ischemic stroke were less likely to be evaluated by stroke specialists and less likely to undergo standard diagnostic testing compared with men.

Keywords: diagnostic evaluation; disparities; ischemic stroke; women.

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Figures

Figure 1
Figure 1
Percentages and 95% CIs of diagnostic testing and specialist evaluation by sex.
Figure 2
Figure 2
Odds ratio associated with female sex in relation to categories of diagnostic evaluation, adjusted for age, race, and number of Charlson comorbidities.
See this image and copyright information in PMC

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