Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Jun 29;21(1):619.
doi: 10.1186/s12913-021-06669-w.

Sex differences in direct healthcare costs following stroke: a population-based cohort study

Amy Y X Yu  1   2   3 , Murray Krahn  4   5   6   7 , Peter C Austin  4   5 , Mohammed Rashid  4 , Jiming Fang  4 , Joan Porter  4 , Manav V Vyas  8   4   5 , Susan E Bronskill  4   5 , Eric E Smith  9 , Richard H Swartz  8   4 , Moira K Kapral  4   5   6
Affiliations

Sex differences in direct healthcare costs following stroke: a population-based cohort study

Amy Y X Yu et al. BMC Health Serv Res. .

Abstract

Background: The economic burden of stroke on the healthcare system has been previously described, but sex differences in healthcare costs have not been well characterized. We described the direct person-level healthcare cost in men and women as well as the various health settings in which costs were incurred following stroke.

Methods: In this population-based cohort study of patients admitted to hospital with stroke between 2008 and 2017 in Ontario, Canada, we used linked administrative data to calculate direct person-level costs in Canadian dollars in the one-year following stroke. We used a generalized linear model with a gamma distribution and a log link function to compare costs in women and men with and without adjustment for baseline clinical differences. We also assessed for an interaction between age and sex using restricted cubic splines to model the association of age with costs.

Results: We identified 101,252 patients (49% were women, median age [Q1-Q3] was 76 years [65-84]). Unadjusted costs following stroke were higher in women compared to men (mean ± standard deviation cost was $54,012 ± 54,766 for women versus $52,829 ± 59,955 for men, and median cost was $36,703 [$16,496-$72,227] for women versus $32,903 [$15,485-$66,007] for men). However, after adjustment, women had 3% lower costs compared to men (relative cost ratio and 95% confidence interval 0.97 [0.96,0.98]). The lower cost in women compared to men was most prominent among people aged over 85 years (p for interaction = 0.03). Women incurred lower costs than men in outpatient care and rehabilitation, but higher costs in complex continuing care, long-term care, and home care.

Conclusions: Patterns of resource utilization and direct medical costs were different between men and women after stroke. Our findings inform public payers of the drivers of costs following stroke and suggest the need for sex-based cost-effectiveness evaluation of stroke interventions with consideration of costs in all care settings.

Keywords: Health services research; Healthcare cost; Sex; Stroke.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Adjusted relative cost ratio of mean total healthcare costs comparing female to male by age (shaded area represents confidence band)
Fig. 2
Fig. 2
Relative change in direct one-year healthcare costs associated with the covariates
Fig. 3
Fig. 3
Mean direct healthcare costs in the year prior and following stroke by healthcare settings and sex
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Krueger H, Koot J, Hall RE, O'Callaghan C, Bayley M, Corbett D. Prevalence of individuals experiencing the effects of stroke in Canada: trends and projections. Stroke. 2015;46(8):2226–2231. doi: 10.1161/STROKEAHA.115.009616. - DOI - PubMed
    1. Feigin VL, Forouzanfar MH, Krishnamurthi R, Mensah GA, Connor M, Bennett DA, Moran AE, Sacco RL, Anderson L, Truelsen T, et al. Global and regional burden of stroke during 1990-2010: findings from the global burden of disease study 2010. Lancet (London, England) 2014;383(9913):245–254. doi: 10.1016/S0140-6736(13)61953-4. - DOI - PMC - PubMed
    1. Petrea RE, Beiser AS, Seshadri S, Kelly-Hayes M, Kase CS, Wolf PA. Gender differences in stroke incidence and poststroke disability in the Framingham heart study. Stroke. 2009;40(4):1032–1037. doi: 10.1161/STROKEAHA.108.542894. - DOI - PMC - PubMed
    1. Reeves MJ, Bushnell CD, Howard G, Gargano JW, Duncan PW, Lynch G, Khatiwoda A, Lisabeth L. Sex differences in stroke: epidemiology, clinical presentation, medical care, and outcomes. Lancet Neurol. 2008;7(10):915–926. doi: 10.1016/S1474-4422(08)70193-5. - DOI - PMC - PubMed
    1. Kim SE, Lee H, Kim JY, Lee KJ, Kang J, Kim BJ, Han MK, Choi KH, Kim JT, Shin DI, et al. Three-month modified Rankin scale as a determinant of 5-year cumulative costs after ischemic stroke: an analysis of 11,136 patients in Korea. Neurology. 2020;94(9):e978–e991. doi: 10.1212/WNL.0000000000009034. - DOI - PubMed