(Stroke. 2000;31:1833.)
© 2000 American Heart Association, Inc.
Original Contributions |
Sex Differences and Similarities in the Management and Outcome of Stroke Patients
From the Institute for Clinical Evaluative Sciences (J.M.H.-L., M.K.K., P.C.A., J.V.T.), Toronto, Ontario; the Division of General Internal Medicine and Clinical Epidemiology Unit and Health Care Research Program, Sunnybrook and Women’s College Health Science Centre (J.V.T.), Toronto, Ontario; and the Department of Medicine (J.M.H.-L., M.K.K., J.V.T.) and Public Health Sciences (P.C.A., J.V.T.) University of Toronto, Toronto, Ontario, Canada.
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Abstract |
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Background and Purpose—Previous studies have documented sex differences in the management and outcome of patients with cardiovascular disease. However, little data exist on whether similar sex differences exist in stroke patients. We conducted a study to determine whether sex differences exist in patients with acute stroke admitted to Ontario hospitals.
Methods—Using linked administrative databases, we performed a
population-based cohort study. The databases contained information on
all 44 832 patients discharged from acute-care hospitals in Ontario
between April 1993 and March 1996 with a most responsible diagnosis of
acute stroke. The main outcomes measured consisted of sex differences
in comorbidities, the use of rehabilitative services, the use of
antiplatelet therapy and anticoagulants (in elderly stroke
survivors aged 
65 years only), discharge destination, and
mortality.
Results—Male stroke patients were more likely than female stroke
patients to have a history of ischemic heart disease (18.1%
versus 15.3%, respectively; P<0.001) and diabetes
mellitus (20.1% versus 18.7%, respectively; P<0.001),
whereas female patients were more likely than male patients to have
hypertension (33.8% versus 30.0%, respectively;
P<0.001) and atrial fibrillation (12.9% versus 10.2%,
respectively; P<0.001). There were no sex differences
in the usage of in-hospital rehabilitative services. The overall 90-day
postdischarge use of aspirin and ticlopidine was similar in stroke
survivors aged 65 to 84 years. However, among stroke survivors aged
85 years, men were more likely than women to receive aspirin (36.0%
versus 30.7%, respectively; P<0.001) and ticlopidine
(9.2% versus 6.8%, respectively; P=0.007). Use of
warfarin was similar for the two sexes. Men were more likely than women
to be discharged home (50.6% versus 40.9%, respectively;
P<0.001) and less likely to be discharged to chronic
care facilities (16.8% versus 25.2%, respectively;
P<0.001). The risk of death 1 year after stroke was
somewhat lower in women than men (adjusted odds ratio 0.939, 95% CI
0.899 to 0.980; P=0.004). The mortality differences were
greatest among elderly stroke patients.
Conclusions—Elderly men are more likely than elderly women to receive aspirin and ticlopidine and equally like to receive warfarin after a stroke. Despite these differences, elderly women have a better 1-year survival after a stroke.
Key Words: anticoagulants • antiplatelet therapy • gender • stroke, acute
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Introduction |
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TopAbstractIntroductionSubjects and MethodsResultsDiscussionReferences |
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The potential for sex bias in the provision of necessary medical services is an issue of increasing concern. Several studies have reported sex differences in the management of patients with cardiovascular disease. Women have been shown to be less likely than men to receive major cardiovascular diagnostic and therapeutic procedures.1 2 In one study, the adjusted odds ratio for invasive coronary procedures in men compared with women was 1.3 for angioplasty and 1.6 for coronary artery bypass surgery.2 These differences exist even after accounting for sex differences in the average age of clinical presentation and other possible confounding factors.3
In contrast, the literature on stroke and sex differences is not as
comprehensive. In particular, there are limited data on sex differences
in the medical and surgical management of stroke patients. Previous
population-based studies have shown that men appear to be at a higher
risk of stroke.4 5 6 7 8 9 10 However, women, on average, live
longer than men, and stroke rates increase with advancing age, so that
in persons aged 85 years, women have a higher incidence of
stroke.11 There do not appear to be any sex differences in
stroke severity.12 13 Stroke mortality rates vary between
studies, but after adjusting for age, men appear to have a higher
mortality rate.6 14
Previous clinical trials have also examined sex differences in the effectiveness of various medical therapies for stroke prophylaxis. Subgroup analyses of some trials of aspirin have failed to show a benefit in women.15 16 17 However, all these studies contained small numbers of women and, therefore, lacked the power to detect a benefit in women. Other studies have found aspirin to be effective in stroke prophylaxis for both sexes.18 19 20 21
Ticlopidine has also been found to be effective in both men and women.22 23 The Ticlopidine Aspirin Stroke Study Group demonstrated a trend toward greater response to ticlopidine in women.23 Warfarin is recommended for stroke prevention in patients with nonvalvular atrial fibrillation and specific stroke risk factors.24 Among those patients with coronary artery disease and atrial fibrillation, women have been found to have a higher incidence of stroke.25 This would suggest that women with nonvalvular atrial fibrillation might obtain more benefit from warfarin use than men.
Sex differences in the therapeutic management of stroke patients have not been previously investigated. The purpose of the present study was to conduct a population-based analysis of sex differences in the medical management and outcome of stroke patients.
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Subjects and Methods |
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TopAbstractIntroductionSubjects and MethodsResultsDiscussionReferences |
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Inclusion Criteria
Data on all patients discharged from acute-care Ontario hospitals for the fiscal years 1993 to 1995 (inclusive) with a most responsible diagnosis (the diagnosis that accounts for most of a hospital stay) of an acute stroke (International Classification of Diseases, 9th Revision [ICD-9] code 431, intracerebral hemorrhage; 434, occlusion of cerebral arteries; or 436, acute but ill-defined cerebrovascular disease) were obtained from the Canadian Institute for Health Information (CIHI) database. A fiscal year was defined as April 1 of that calendar year to March 31 of the subsequent year.
The CIHI database contains demographic, length of stay (LOS), comorbidity, in-hospital mortality, and discharge destination information on all patients admitted to Ontario hospitals. The most responsible and up to 15 secondary diagnoses are coded in the CIHI database according to the ICD-9 coding system.26 The CIHI database also codes as many as 10 procedures according to the Canadian Classification of Procedures27 and documents each patient’s receipt of rehabilitation services, such as occupational therapy, physiotherapy, and speech/language pathology.
Prescriptions filled for aspirin, ticlopidine, and warfarin in stroke
survivors aged 65 years were obtained from the Ontario Drug Benefit
(ODB) database from April 1, 1993, to June 30, 1996. The ODB database
contains all prescriptions filled in Ontario by persons aged 65 years
for prescription medications from a minimally restrictive formulary.
This database was linked to the CIHI database by use of anonymous
patient identifiers and observed for 90 days after discharge. The
30-day and 1-year mortality status of patients were obtained from
provincial vital statistics.
Stroke Risk Factors and Comorbidities
The frequency of patients with various stroke risk factors and
other comorbid diseases was determined with use of the appropriate
ICD-9 codes in the 15 secondary diagnosis fields of the CIHI database.
The stroke risk factors and comorbidities included ischemic
heart disease, congestive heart failure, atrial fibrillation,
peripheral vascular disease, chronic pulmonary
disease, peptic ulcer disease, liver disease, malignancy, renal
disease, hypertensive disease, and diabetes mellitus. The adaptation by
Deyo et al28 of the Charlson index score was also used to
quantify overall comorbid disease status.
Exclusion Criteria
We excluded from the present study patients who were aged
<20 or >105 years, persons with a total LOS of 365 days, and
strokes occurring as an in-hospital procedural complication.
Outcome Measures
The outcome measures assessed included rehabilitative services,
prescription use of aspirin, ticlopidine, and warfarin within 90 days
of discharge, median LOS after stroke, destination at discharge, and
unadjusted and adjusted 30-day and 1-year mortality.
Statistical Analysis
Two-way contingency tables were used to test for associations
between sex and each variable, stratified by age.
2 tests were used to test for statistically
significant differences between the sexes. Median 2-sample tests were
used to test the equalities of LOS between the sexes within each age
range. Logistic regression was used to determine the adjusted odds
ratio of mortality at 30 days and at 1 year. Age,
age2, age3, sex, risk
factors, and comorbid conditions were used as regressors. All
statistical analyses were conducted by use of the statistical
program SAS Release 6.11 (SAS Institute, Inc).29
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Results |
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Patient Demographics and Comorbid Disease
Overall, 44 832 patients were admitted to an Ontario hospital with an acute stroke during the fiscal years 1993 to 1995. The distribution by sex was approximately equal, with 49.7% men and 50.3% women. However, the male patients tended to be younger than the female patients (mean age 71.3 versus 75.5 years, respectively; P<0.001).
The most common comorbid conditions were ischemic heart
disease, diabetes mellitus, hypertension, and atrial fibrillation
(Table 1
). Men were more likely
than women to have a history of ischemic heart disease and
diabetes mellitus, whereas women had a higher prevalence of atrial
fibrillation and hypertension. The Deyo-Charlson index
scores28 indicated that men had a higher overall frequency
of comorbid diseases at the time of presentation.
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Use of Rehabilitative Services and Secondary Stroke Prevention
Medications
The in-hospital utilization of rehabilitation services was similar
in men and women (Table 2). Among
patients aged <85 years, use of aspirin and ticlopidine was similar in
men and women (Table 3). However, among
patients aged 85 years, men were more likely than women to receive
aspirin (36.0% versus 30.7%, respectively; P<0.001) and
ticlopidine (9.2% versus 6.8%, respectively; P=0.007).
There was no sex difference in the use of warfarin within any age
group.
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Outcome Measures
Although in the younger age group, there was no sex difference in
short-term and long-term mortality rates, older men had higher
mortality rates than did older women (Table 4). The adjusted odds ratio for 30-day
mortality in females compared with males was 0.956 (95% CI 0.910 to
1.005, P=0.0.0791). The adjusted odds ratio for 1-year
mortality in females compared with males was 0.939 (95% CI 0.899 to
0.980, P=0.004). Within each sex, the mortality rates
increased with age.
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Men had a shorter median LOS than did women (9 days versus 11 days,
respectively; P<0.001). Men were more likely than women to
be discharged home (50.6% versus 40.9%, respectively;
P<0.001) and less likely than women to be discharged to
chronic care facilities (16.8% versus 25.2%, respectively;
P<0.001) (Table 5). Men and
women were equally likely to be discharged to rehabilitation
facilities.
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Discussion |
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The present study is one of the first population-based studies to examine sex differences in the management and outcome of stroke patients. We found no significant differences in the outcome of younger men and women with stroke. Among older patients, however, men were more likely than women to receive secondary preventative therapy with aspirin and ticlopidine. This sex difference in prescribing is not supported by current evidence and recommendations for the use of aspirin and ticlopidine for secondary stroke prevention in men and women.18 19 20 21 22 23
The sex difference in the use of antiplatelet therapy cannot be accounted for by the use of warfarin. In fact, although women had a higher rate of atrial fibrillation, there was no sex difference in the use of warfarin.
One explanation for the lower use of antiplatelet therapy in older women might be the presence of comorbid conditions or contraindications. However, we found that older women in fact appeared to have less comorbidity at the time of stroke and were more likely to survive the event. Men may have been more likely to be on aspirin because of their higher rate of ischemic heart disease; however, this is unlikely to be the full explanation, given the similar prevalence of ischemic heart disease in men and women aged >85 years.
Another possible contributing factor to the sex differences in antiplatelet therapy may be that among older stroke survivors, women were more likely to be institutionalized and possibly to have more disability. Physicians may be more aware of the benefits of stroke prevention when the individual is living in the community with only minimal disability.
The present study has a number of limitations. First, comorbid
diseases may be undercoded in the CIHI database. However, we would not
expect to see sex differences in data coding, making the impact of
undercoding less important to the overall conclusions of the
present study. Also, the accuracy of ICD-9 coding of stroke,
patient demographics, and discharge disposition in the CIHI database
has been validated in other studies.30 31 Second, the ODB
database does not contain drug data on patients aged <65 years.
Therefore, our conclusions regarding prescribing patterns are limited
to individuals aged 65 years. Although aspirin can be purchased by
the patient without a prescription, the Ontario government assumes the
complete cost if aspirin is prescribed by a physician. Therefore, a few
stroke patients on aspirin may be missing from the ODB database, but
this is probably a minor contribution.
In conclusion, we found there were no differences in the outcome of stroke for younger men and women. Among older patients, in contrast, men were more likely than women to be prescribed aspirin and ticlopidine, both of which have been shown to be effective in secondary stroke prevention. We also found that despite the higher rate of atrial fibrillation among women, there was no sex difference in the use of warfarin. Overall, elderly women had better short-term and long-term survival rates than did elderly men. Further research is needed to determine the reasons for these differences in stroke management and outcome.
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Acknowledgments |
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This study was supported by the Institute for Clinical Evaluative Sciences in Ontario. Dr Tu is supported in part by a Medical Research Council of Canada Scholar Career Award.
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Footnotes |
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Reprint requests to Dr Jack V. Tu, Senior Scientist, Institute for Clinical Evaluative Sciences, G-106, 2075 Bayview Ave, Toronto, Ontario, Canada M4N 3M5.
The Institute for Clinical Evaluative Sciences is supported by the Ontario Ministry of Health. Neither the findings nor their interpretation should be attributed to any supporting or sponsoring agencies.
Received March 2, 2000; revision received May 10, 2000; accepted May 10, 2000.
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References |
|---|
|
TopAbstractIntroductionSubjects and MethodsResultsDiscussionReferences |
|---|
- Ayanian JZ, Epstein AM. Differences in the use of procedures between women and men hospitalized for coronary heart disease. N Engl J Med. 1991;325:221–225.[Abstract]
- Jaglal SB, Goel V, Naylor CD. Sex differences in the use of invasive coronary procedures in Ontario. Can J Cardiol. 1994;10:239–244.[Medline] [Order article via Infotrieve]
- Khan SS, Nessim S, Gray R, Czer LS, Chaux A, Matloff J. Increased mortality of women in coronary artery bypass surgery: evidence for referral bias. Ann Intern Med. 1990;112:561–567.
- Bonita R, Anderson CS, Broad JB, Jamrozik KD, Stewart-Wynne EG, Anderson NE. Stroke incidence and case fatality in Australasia: a comparison of the Auckland and Perth population-based stroke registers. Stroke. 1994;25:552–557.[Abstract]
- Brown RD, Whisnant JP, Sicks JD, O’Fallon WM, Wiebers DO. Stroke incidence, prevalence, and survival: secular trends in Rochester, Minnesota, through 1989. Stroke. 1996;27:373–380.
-
Tuomilehto J, Rastenyte D, Sivenius J, Sarti C,
Immonen-Raiha P, Kaarsalo E, Kuulasmaa K, Narva EV, Salomaa V, Salmi K,
et al. Ten-year trends in stroke incidence and mortality in the
FINMONICA stroke study. Stroke. 1996;27:825–832.
[Abstract/Free Full Text] -
Ryglewicz D, Polakowska M, Lechowicz W, Broda G,
Roszikiewicz M, Jasinski B, Hier DB. Stroke mortality rates in Poland
did not decline between 1984 and 1992. Stroke. 1997;28:752–757.
[Abstract/Free Full Text] -
Stegmayr B, Asplund K, Kuulasmaa K, Rajakangas A-M,
Thorvaldsen P, Tuomilehto J, for the WHO MONICA project. Stroke
incidence and mortality correlated to stroke risk factors in the WHO
MONICA project: an ecological study of 18 populations.
Stroke. 1997;28:1367–1374.
[Abstract/Free Full Text] -
Huang Z-S, Chiang T-L, Lee T-K. Stroke prevalence in
Taiwan: findings from the 1994 National Health Interview survey.
Stroke. 1997;28:1579–1584.
[Abstract/Free Full Text] - Stegmayr B, Asplund K. Exploring the declining case fatality in acute stroke: population-based observations in the northern Sweden MONICA project. J Intern Med. 1996;240:143–149.[Medline] [Order article via Infotrieve]
-
Barker WH, Mullooly JP. Stroke in a defined elderly
population, 1967–1985: a less lethal and disabling but no less common
disease. Stroke. 1997;28:284–290.
[Abstract/Free Full Text] - Taub NA, Wolfe CDA, Richardson E, Burney PGJ. Predicting the disability of first-time stroke sufferers at 1 year: 12-month follow-up of a population-based cohort in Southeast England. Stroke. 1994;25:352–357.[Abstract]
- Smurawska LT, Alexandrov AV, Bladin CF, Norris JW. Cost of acute stroke care in Toronto, Canada. Stroke. 1994;25:1628–1631.[Abstract]
-
Modan B, Wagener DK. Some epidemiological aspects of
stroke: mortality/morbidity trends, age, sex, race, socioeconomic
status. Stroke. 1992;23:1230–1236.
[Abstract/Free Full Text] - Candelise L, Landi G, Perrone P, Bracchi M, Brambilla G. A randomized trial of aspirin and sulfinpyrazone in patients with TIA. Stroke. 1982;13:175–179.[Abstract]
- The Canadian Cooperative Study Group. A randomized trial of aspirin and sulfinpyrazone in threatened stroke. N Engl J Med. 1978;299:53–59.[Abstract]
-
Sze PC, Reitman D, Pincus MM, Sacks HS, Chalmers TC.
Antiplatelet agents in the secondary prevention of stroke:
meta-analysis of the randomized control trials.
Stroke. 1988;19:436–442.
[Abstract/Free Full Text] - Bousser MG, Eschwege E, Haguenau M, Lefaucconnier JM, Thibult N, Touboul D, Toubol PJ. ‘AICLA’ controlled trial of aspirin and dipyridamole in the secondary prevention of atherothrombotic cerebral ischemia. Stroke. 1983;14:5–14.[Abstract]
-
ESPS Group. European stroke prevention study.
Stroke. 1990;21:1122–1130.
[Abstract/Free Full Text] -
Sivenius J, Laakso M, Penttila IM, Smets P, Lowenthal
A, Riekkinen PJ. The European stroke prevention study: results
according to sex. Neurology. 1991;41:1189–1192.
[Abstract/Free Full Text] - The SALT Collaborative Group. Swedish aspirin low-dose trial (SALT) of 75 mg aspirin as secondary prophylaxis after cerebrovascular ischaemic events. Lancet. 1991;338:1345–1349.[Medline] [Order article via Infotrieve]
- Gent M, Blakely JA, Easton JD, Ellis DJ, Hachinski VC, Harbison JW, Panak E, Roberts RS, Sicurella J, Turpie AG. The Canadian American ticlopidine study (CATS) in thromboembolic stroke. Lancet. 1989;1:1215–1220.[Medline] [Order article via Infotrieve]
- The Ticlopidine Aspirin Stroke Study Group. A randomized trial comparing ticlopidine hydrochloride with aspirin for the prevention of stroke in high-risk patients. N Engl J Med. 1989;321:501–507.[Abstract]
-
Gorelick PB, Sacco RL, Smith DB, Alberts M,
Mustone-Alexander L, Rader D, Ross JL, Raps E, Ozer MN, Brass LM, et
al. Prevention of a first stroke: a review of guidelines and a
multidisciplinary consensus statement from the national stroke
association. JAMA. 1999;281:1112–1120.
[Abstract/Free Full Text] -
Wolf PA, Abbott RD, Kannel WB. Atrial
fibrillation as an independent risk factor for stroke: the Framingham
Study. Stroke. 1991;22:983–988.
[Abstract/Free Full Text] - International Classification of Diseases, 9th revision, Clinical Modification. Ann Arbor, Mich:. Commission on Professional and Hospital Activities; 1992.
- Canadian Classification of Diagnostic, Therapeutic, and Surgical Procedures. Ottawa, Ontario: Minister of Industry, Science and Technology; 1993.
- Deyo RA, Cherkin DC, Ciol MA. Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. J Clin Epidemiol. 1992;45:613–619.[Medline] [Order article via Infotrieve]
- SAS Release 6.11. Cary, NC: SAS Institute Inc; 1996.
- Mayo NE, Chockalingam A, Reeder BA, Phillips S. Surveillance for stroke in Canada. Health Rep. 1994;6:62–72.[Medline] [Order article via Infotrieve]
- Ontario Hospital Association, Ontario Ministry of Health, Hospital Medical Records Institute. Report of the Ontario Data Quality Reabstracting Study. Toronto, Ontario: Ontario Hospital Association; 1991.
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