- Title
- Factors contributing to sex differences in functional outcomes and participation after stroke
- Creator
- Phan, Hoang T.; Blizzard, Christopher L.; Reeves, Mathew J.; Thrift, Amanda G.; Cadilhac, Dominique A.; Sturm, Jonathon; Heeley, Emma; Otahal, Petr; Vemmos, Konstantinos; Anderson, Craig; Parmar, Pryia; Krishnamurthi, Rita; Barker-Collo, Suzanne; Feigin, Valery; Bejot, Yannick; Cabral, Norberto Luiz; Carolei, Antonio; Sacco, Simona; Chausson, Nicolas; Olindo, Stephane; Rothwell, P; Silva, C; Correia, M; Magalhães, R; Appelros, P; Kõrv, J; Vibo, R; Minelli, C; Gall, SL
- Relation
- NHMRC.1042600
- Relation
- Neurology Vol. 90, Issue 22, p. e1945-e1953
- Publisher Link
- http://dx.doi.org/10.1212/WNL.0000000000005602
- Publisher
- Lippincott Williams & Wilkins
- Resource Type
- journal article
- Date
- 2018
- Description
- Objective: To examine factors contributing to the sex differences in functional outcomes and participation restriction after stroke. Methods: Individual participant data on long-term functional outcome or participation restriction (i.e., handicap) were obtained from 11 stroke incidence studies (1993-2014). Multivariable log-binomial regression was used to estimate the female: male relative risk (RR) of poor functional outcome (modified Rankin Scale score >2 or Barthel Index score <20) at 1 year (10 studies, n = 4,852) and 5 years (7 studies, n = 2,226). Multivariable linear regression was used to compare the mean difference (MD) in participation restriction by use of the London Handicap Scale (range 0-100 with lower scores indicating poorer outcome) for women compared to men at 5 years (2 studies, n = 617). For each outcome, study-specific estimates adjusted for confounding factors (e.g., sociodemographics, stroke-related factors) were combined with the use of random-effects meta-analysis. Results: In unadjusted analyses, women experienced worse functional outcomes after stroke than men (1 year: pooled RRunadjusted 1.32, 95% confidence interval [CI] 1.18-1.48; 5 years: RRunadjusted 1.31, 95% CI 1.16-1.47). However, this difference was greatly attenuated after adjustment for age, prestroke dependency, and stroke severity (1 year: RRadjusted 1.08, 95% CI 0.97-1.20; 5 years: RRadjusted 1.05, 95% CI 0.94-1.18). Women also had greater participation restriction than men (pooled MDunadjusted-5.55, 95% CI -8.47 to -2.63), but this difference was again attenuated after adjustment for the aforementioned factors (MDadjusted-2.48, 95% CI -4.99 to 0.03). Conclusions: Worse outcomes after stroke among women were explained mostly by age, stroke severity, and prestroke dependency, suggesting these potential targets to improve the outcomes after stroke in women.
- Subject
- sex differences; female; male; sex; stroke; SDG 3; Sustainable Development Goals
- Identifier
- http://hdl.handle.net/1959.13/1442570
- Identifier
- uon:41725
- Identifier
- ISSN:0028-3878
- Language
- eng
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