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
. 2023 Jun;8(2):557-565.
doi: 10.1177/23969873231156260. Epub 2023 Mar 2.

Sex and gender differences in acute stroke care: metrics, access to treatment and outcome. A territorial analysis of the Stroke Code System of Catalonia

Yolanda Silva  1 , Laura Sánchez-Cirera  1 , Mikel Terceño  1 , Laura Dorado  2 , Adrián Valls  2 , Marina Martínez  2 , Sònia Abilleira  3 , Marta Rubiera  4 , Helena Quesada  5 , Laura Llull  6 , Ana Rodríguez-Campello  7 , Joan Martí-Fàbregas  8 , Laia Seró  9 , Francisco Purroy  10 , Iago Payo  11 , Sònia García  12 , David Cánovas  13 , Jurek Krupinski  14 , Natalia Mas  15 , Ernest Palomeras  16 , Dolores Cocho  17 , Maria Àngels Font  18 , Esther Catena  19 , Elsa Puiggròs  20 , Claudia Pedroza  21 , Gemma Marín  22 , Dolors Carrión  23 , Xavier Costa  24 , Mari Cruz Almendros  25 , Ivan Torres  26 , Carla Colom  27 , John Alejandro Velasquez  28 , Gloria Diaz  29 , Xavier Jiménez  30 , Teresa Subirats  30 , Anna Deulofeu  30 , Verónica Hidalgo  7 , Mercè Salvat-Plana  31 , Natalia Pérez de la Ossa  2   31
Affiliations

Sex and gender differences in acute stroke care: metrics, access to treatment and outcome. A territorial analysis of the Stroke Code System of Catalonia

Yolanda Silva et al. Eur Stroke J. 2023 Jun.

Abstract

Introduction: Previous studies have reported differences in the management and outcome of women stroke patients in comparison with men. We aim to analyze sex and gender differences in the medical assistance, access to treatment and outcome of acute stroke patients in Catalonia.

Patients and methods: Data were obtained from a prospective population-based registry of stroke code activations in Catalonia (CICAT) from January/2016 to December/2019. The registry includes demographic data, stroke severity, stroke subtype, reperfusion therapy, and time workflow. Centralized clinical outcome at 90 days was assessed in patients receiving reperfusion therapy.

Results: A total of 23,371 stroke code activations were registered (54% men, 46% women). No differences in prehospital time metrics were observed. Women more frequently had a final diagnosis of stroke mimic, were older and had a previous worse functional situation. Among ischemic stroke patients, women had higher stroke severity and more frequently presented proximal large vessel occlusion. Women received more frequently reperfusion therapy (48.2% vs 43.1%, p < 0.001). Women tended to present a worse outcome at 90 days, especially for the group receiving only IVT (good outcome 56.7% vs 63.8%; p < 0.001), but not for the group of patients treated with IVT + MT or MT alone, although sex was not independently associated with clinical outcome in logistic regression analysis (OR 1.07; 95% CI, 0.94-1.23; p = 0.27) nor in the analysis after matching using the propensity score (OR 1.09; 95% CI, 0.97-1.22).

Discussion and conclusion: We found some differences by sex in that acute stroke was more frequent in older women and the stroke severity was higher. We found no differences in medical assistance times, access to reperfusion treatment and early complications. Worse clinical outcome at 90 days in women was conditioned by stroke severity and older age, but not by sex itself.

Keywords: Acute stroke; gender; outcome; sex.

PubMed Disclaimer

Conflict of interest statement

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Source of stroke code activation by sex and stroke severity. EMS: Emergency Medical Services; ER: Emergency room.
Figure 2.
Figure 2.
Proportion of cases by age and stroke severity among men and women (excluding stroke mimic).
See this image and copyright information in PMC

References

    1. Girijala RL, Sohrabji F, Bush RL. Sex differences in stroke: review of current knowledge and evidence. Vasc Med 2017; 22: 135–145. - PubMed
    1. Rexrode KM, Madsen TE, Yu AYX, et al.. The impact of sex and gender on stroke. Circ Res 2022; 130: 512–528. - PMC - PubMed
    1. Bushnell C, Howard VJ, Lisabeth L, et al.. Sex differences in the evaluation and treatment of acute ischaemic stroke. Lancet Neurol 2018; 17: 641–650. - PubMed
    1. Towfighi A, Markovic D, Ovbiagele B. Sex differences in revascularization interventions after acute ischemic stroke. J Stroke Cerebrovasc Dis 2013; 22: e347–e353. - PubMed
    1. Carcel C, Wang X, Sandset EC, et al.. Sex differences in treatment and outcome after stroke: pooled analysis including 19,000 participants. Neurology 2019; 93: e2170–e2180. - PubMed