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Gender Differences Appear in First-Stoke Clinical Presentation, Resource Use And Outcomes: Presented at ESC

By Bruce Sylvester
Special to DG News

GENEVA, SWITZERLAND -- June 3, 2002 -- A large international, multi-center study has found significant gender differences in hospital admissions, treatments and outcomes for patients with acute stroke.

Researchers speaking here Friday at the European Stroke Conference (ESC) say their findings suggest that gender-related treatment decisions and socio-demographic factors may influence first-stroke outcomes.

"Sex differences in cardiac care have received wide study," said lead author Domenico Inzitari, MD, professor of neurology at the University of Fiernze in Italy, "but this has not been the case with stroke."

In a European Concerted Action involving seven countries, the investigators gathered data on 4499 patients admitted to participating hospitals for first-ever stroke. The researchers evaluated for demographics, risk factors, clinical presentation, resource use, and three-month survival, disability on the Barthel index and handicap (Rankin grade).

Of the total pool of subjects, 2239 patients (49.8 percent) were men, mean age 69.2±12.1 years, and 2260 (50.2 percent) were women, mean age 74.5±12.5 years. "The difference in age is consistent with the fact that women tend to have a first stroke several years later than men," said Dr. Inzitari.

Upon hospital admission for their first stroke, more women had been living in an institution. The women also had a lower mean pre-stroke Rankin score (all p<0.001).

Hypertension (p=0.007) and atrial fibrillation (p<0.001) appeared significantly more often in the women's medical histories. Coma (p<0.001), paralysis (p<0.001), aphasia (p=0.001), swallowing problems (p=0.005) and urinary incontinence (p<0.001) all appeared more frequently in women than men during the acute phase of hospitalization.

However, the researchers also found that brain imaging, Doppler examination, echocardiograms, and angiography were significantly less frequently performed on the women (p values <0.001 for all categories of testing).

"Diagnostic resources were used less for the women than the men, in spite of the fact that, as a group, they had more pre-stroke medical problems," said Dr. Inzitari. "This is what we found in this large, international group, and why it is so, we can't say."

Performance of carotid surgery also was significantly less frequent among the women (p<0.001).

The investigators found that the three-month follow-up data, controlling for all baseline and clinical variables, indicated that female sex was a significant predictor of disability (odds ratio [OR], 1.40; 95 percent confidence interval [CI], 1.10-1.80) and handicap (OR, 1.49; 95 percent CI, 1.18-1.88). However, they found no significant gender effect on three-month survival rates.

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