on July 10, 2003
Stroke. 2003
Published online before print July 10, 2003, doi: 10.1161/01.STR.0000083534.81284.C5
Published online before print July 10, 2003, doi: 10.1161/01.STR.0000083534.81284.C5
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Submitted on March 20, 2003
From the Department of Public Health and Clinical Medicine, University Hospital Umeå, Umeå (E.-L.G., B.S., P.-O.W., K.A.); Department of Clinical Neuroscience, Lund University, Lund (B.N.); Department of Medical Science, Uppsala University, Uppsala (A.T.); and Department of Medicine, Enköping Hospital, Enköping (K.H.-Å.), Sweden. * To whom correspondence should be addressed. E-mail: eva-lotta.glader{at}medicin.umu.se.
Background and Purpose--It is disputed whether there are sex differences in management and outcome after stroke; early studies have shown inconsistent results. The objective of this study was to verify and explain differences between men and women in management and outcome after stroke in a national perspective. Methods--In 2001, 20 761 stroke patients were registered in Riks-Stroke, the national quality register for stroke care in Sweden in which all 84 hospitals participate. Data from 9 hospitals that had reported <70% of the estimated stroke events were excluded from analyses, leaving 19 547 patients (9666 women, 9881 men) at 75 hospitals for the present analyses. Results--Women were older than men (77.8 versus 73.2 years). After age adjustment, female patients were more often disabled, living at home with community support, or in institutions before the stroke. They also had a different cardiovascular risk factor profile. Case fatality ratios during the first 3 months were similar in men and women. After 3 months, more women were physically and mentally impaired and dependent on other persons. Female patients with atrial fibrillation received oral anticoagulants less often than men. Even after multiple adjustments for differences between sexes, female sex was independently associated with institutional living 3 months after the stroke (odds ratio, 1.2; 95% confidence interval, 1.0 to 1.4). Conclusions--Women have a worse prestroke condition. Except for case fatality ratios, they also have a worse outcome after stroke after adjustment for other prognostic factors. There are also sex differences in the medical management of stroke that need to be rectified.
Accepted on April 17, 2003
Sex Differences in Management and Outcome After Stroke. A Swedish National Perspective
Eva-Lotta Glader MD*;
Key words: delivery of health care • gender • stroke management • stroke outcome
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|
|
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|
|
|
|
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|
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|
|
|
|
|
|
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|
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|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
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|
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|
|
|
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|
|
|
|
|
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|
|
|
|
 |
|
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|
|
|
|
|
|
A. G. Rudd and D. B. Matchar Health Policy and Outcome Research in Stroke Stroke, February 1, 2004; 35(2): 397 - 400. [Full Text] [PDF]
|
|
|
|
 |
|
 Stroke Management and Outcomes Differ Between Swedish Women and Men Journal Watch Women's Health, October 8, 2003; 2003(1008): 3 - 3. [Full Text]
|
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