This Article Full Text Full Text (PDF) All Versions of this Article: 38/7/2123    most recent STROKEAHA.106.478495v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Foerch, C. Search for Related Content PubMed PubMed Citation Articles by Foerch, C. Pubmed/NCBI databases Medline Plus Health Information Stroke Related Collections Acute Cerebral Hemorrhage Acute Cerebral Infarction Emergency treatment of Stroke

(Stroke. 2007;38:2123.)
© 2007 American Heart Association, Inc.

Original Contributions

Sex Disparity in the Access of Elderly Patients to Acute Stroke Care

Christian Foerch, MD; Bjoern Misselwitz, PhD; Marek Humpich, MD; Helmuth Steinmetz, MD; Tobias Neumann-Haefelin, MD; Matthias Sitzer, MD for the Arbeitsgruppe Schlaganfall Hessen

From the Department of Neurology (C.F., M.H., H.S., T.N.-H., M.S.), Johann Wolfgang Goethe University, Frankfurt am Main, and Geschaeftsstelle Qualitaetssicherung Hessen (B.M.), Eschborn, Germany.

Correspondence to Christian Foerch, MD, Department of Neurology, Johann Wolfgang Goethe University, Schleusenweg 2-16, 60528 Frankfurt am Main, Germany. E-mail foerch{at}em.uni-frankfurt.de

Background and Purpose— Sex differences in the management of acute coronary symptoms are well documented. We sought to determine whether sex disparities exist in acute stroke management, particularly with regard to early hospital admission and thrombolytic therapy.

Methods— We analyzed a prospective, countywide, hospital-based stroke registry. Between 1999 and 2005, all cases with a final diagnosis of cerebral infarction (ICD-10 I63) or intracerebral hemorrhage (ICD-10 I61) were selected. Datasets with missing values for sex and time to admission, as well as datasets of patients transferred between hospitals in the acute phase, were excluded. Main outcome measures were the probability of being admitted within the first 3 hours of stroke onset and being treated with thrombolytic agents for both women and men, after adjustment for age, prestroke disability, severity of clinical symptoms, vascular risk factors, and final diagnosis.

Results— Fifty-three thousand four hundred fourteen patients were included (49.3% female; mean±SD age, 72.1±12.5 years). Women had a 10% lower chance of being admitted within the first 3 hours than men (odds ratio=0.902, 95% CI=0.860 to 0.945, P<0.001). This chance further decreased in elderly women. Similarly, the chance of a female stroke patient being treated with thrombolysis was 13% lower than that of a male patient (odds ratio=0.867, 95% CI=0.782 to 0.960, P=0.006). For patients admitted within the 3-hour time window, the chance of being treated with thrombolysis was similar for women and men (odds ratio=0.915, 95% CI=0.809 to 1.035, P=0.156).

Conclusions— We identified sex disparities in acute stroke management in terms of early hospital admission and thrombolytic treatment. This is best explained by the sociodemographic fact that "surviving spouses" are more likely to be women than men. Attempts to overcome disadvantages in their access to acute stroke care should focus on increased social support.

Key Words: cerebral infarct • intracerebral hemorrhage • acute management • women

This article has been cited by other articles:

				L. D. Lisabeth, D. L. Brown, R. Hughes, J. J. Majersik, and L. B. Morgenstern Acute Stroke Symptoms: Comparing Women and Men Stroke, June 1, 2009; 40(6): 2031 - 2036. [Abstract] [Full Text] [PDF]

				M. Reeves, A. Bhatt, P. Jajou, M. Brown, and L. Lisabeth Sex Differences in the Use of Intravenous rt-PA Thrombolysis Treatment for Acute Ischemic Stroke: A Meta-Analysis Stroke, May 1, 2009; 40(5): 1743 - 1749. [Abstract] [Full Text] [PDF]

				J. D. Lewsey, M. Gillies, P. S. Jhund, J. W.T. Chalmers, A. Redpath, A. Briggs, M. Walters, P. Langhorne, S. Capewell, J. J.V. McMurray, et al. Sex Differences in Incidence, Mortality, and Survival in Individuals With Stroke in Scotland, 1986 to 2005 Stroke, April 1, 2009; 40(4): 1038 - 1043. [Abstract] [Full Text] [PDF]

				J. W. Gargano, S. Wehner, and M. J. Reeves Do Presenting Symptoms Explain Sex Differences in Emergency Department Delays Among Patients With Acute Stroke? Stroke, April 1, 2009; 40(4): 1114 - 1120. [Abstract] [Full Text] [PDF]

				M. J. Reeves, G. C. Fonarow, X. Zhao, E. E. Smith, L. H. Schwamm, and on behalf of the GWTG-Stroke Steering Committee & Quality of Care in Women With Ischemic Stroke in the GWTG Program Stroke, April 1, 2009; 40(4): 1127 - 1133. [Abstract] [Full Text] [PDF]

				K. D. Palnum, G. Andersen, A. Ingeman, B. R. Krog, P. Bartels, and S. P. Johnsen Sex-Related Differences in Quality of Care and Short-Term Mortality Among Patients With Acute Stroke in Denmark: A Nationwide Follow-Up Study Stroke, April 1, 2009; 40(4): 1134 - 1139. [Abstract] [Full Text] [PDF]

				M. Eriksson, E.-L. Glader, B. Norrving, A. Terent, and B. Stegmayr Sex Differences in Stroke Care and Outcome in the Swedish National Quality Register for Stroke Care Stroke, March 1, 2009; 40(3): 909 - 914. [Abstract] [Full Text] [PDF]