J Neurocrit Care.  2019 Dec;12(2):92-97. 10.18700/jnc.190108.

Sex disparity in acute ischemic stroke outcomes in Korea

• Gwak BC
• Kim GY
• Park HJ
• Kwon SM
• O SI
• Kim DH
• Jeong JH
• Cha JK

• KMID: 2470470
• DOI: http://doi.org/10.18700/jnc.190108

Abstract

BACKGROUND
It is unclear whether women diagnosed with acute ischemic stroke (AIS) have worse outcome after adjusting for several confounding factors such as age, initial stroke severity, and risk factors. In this study, we investigated sex disparities in long-term functional outcome after AIS.
METHODS
We recruited patients with AIS prospectively registered in the Clinical Research Collaboration for Stroke in Korea database of Dong-A University Stroke Center between 2015 and 2018. We reviewed the patients' clinical demographics, living type (alone or cohabitating), laboratory and radiological findings, stroke severity, stroke subtype, and cardiovascular risk profile. We compared the long-term functional outcomes between men and women using the modified Rankin Scale score at 90 days and 1 year after AIS.
RESULTS
A total of 2,711 patients with AIS were enrolled in this study. Women comprised 38.9% (1,055) of all participants. Compared with men, women were significantly older (72.7±11.6 vs.65.6±12.2, P<0.01), showed more severe neurologic deficits (median National Institutes of Health Stroke Scale, 5 vs. 4, P<0.01), and had a higher rate of living alone (57.1% vs. 42.9%, P<0.01) and a higher prevalence of poor functional outcome at 90 days and 1 year after AIS. However, differences in history of statin use, hospital arrival time, and thrombolysis between the two sexes were not observed. After adjusting for several confounding factors, differences in initial neurologic deficits or long-term functional outcomes between sexes were not observed.
CONCLUSION
This study demonstrated the absence of sex disparities in the status of medical attention for thrombolysis.

Keyword

Stroke; Sex; Marital status; Treatment outcome

MeSH Terms

Cooperative Behavior
Demography
Female
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Korea*
Male
Marital Status
National Institutes of Health (U.S.)
Neurologic Manifestations
Prevalence
Prospective Studies
Risk Factors
Stroke*
Treatment Outcome

Figure

• 

  Fig. 1. Distribution of poor functional outcome at 90 days after the diagnosis of acute ischemic stroke by age and sex in the total population. Poor functional outcome (modified Rankin Scale [mRS] score >2). Any significant difference in poor functional outcome after acute ischemic stroke between both sexes in 80 years or older population (odds ratio, 1.39; 95% confidence interval, 0.84 to 2.29; P=0.20) (Supplementary Table 3) after adjusting for age, National Institutes of Health Stroke Scale score, living type, hospital arrival time, mechanical thrombectomy, previous history of statin use, previous history of atrial fibrillation, previous history of coronary artery disease, and stroke subtypes.

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