on February 24, 2005
Published online before print February 24, 2005, doi: 10.1161/01.STR.0000157662.09551.e5
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Submitted on November 1, 2004
From the Department of Medicine, University of Toronto (M.K.K., F.S., C.J., A.M.C.), Ontario, Canada; Department of Health Policy, Management, and Evaluation, University of Toronto (M.K.K., A.M.C.), Ontario, Canada; Institute for Clinical Evaluative Sciences (M.K.K., J.F., J.R.), Toronto, Ontario, Canada; Division of General Internal Medicine and Clinical Epidemiology, and Women’s Health Program, University Health Network (M.K.K, A.M.C.), Toronto, Ontario, Canada; Division of Neurology, University Health Network (F.S., C.J.), Toronto, Ontario, Canada; and Departments of Clinical Neurosciences/Medicine/Community Health Sciences (M.D.H.), University of Calgary, Alberta, Canada. * To whom correspondence should be addressed. E-mail: moira.kapral{at}uhn.on.ca.
Background--Stroke is an important cause of death and disability in women as well as men. However, little is known about sex differences in stroke care and outcomes. Methods--The Registry of the Canadian Stroke Network (RCSN) captured data on patients with stroke seen at acute care hospitals across Canada. We used data from phase 1 (July 2001 to February 2002) and phase 2 (June to December 2002) of the RCSN to compare stroke presentation, management, and 6-month outcomes in women and men using multivariable regression techniques to adjust for age and other factors. Results--The study sample included 3323 patients, with 1527 women. Stroke symptoms at presentation were similar in women and men, except that women were more likely to present with headaches and were less likely to have brain stem or cerebellar symptoms. There were no sex differences in the use of neuroimaging, thrombolysis, antithrombotic therapy, or consultations. Women were less likely than men to receive care on an acute stroke unit, but this difference was no longer significant after adjustment for age and other factors. Women were more likely than men to be discharged to long-term care and had greater disability at 6 months. Mortality and quality of life at 6 months were similar in women and men. Conclusions--Among patients participating in the RCSN, there were no major sex differences in stroke presentation or management. Compared with men, women were more often institutionalized and had a slightly worse functional status at 6 months after stroke.
Revised on December 20, 2004
Accepted on December 24, 2004
Sex Differences in Stroke Care and Outcomes. Results From the Registry of the Canadian Stroke Network
Moira K. Kapral MD, MSc, FRCPC*;
From the Department of Medicine, University of Toronto (M.K.K., F.S., C.J., A.M.C.), Ontario, Canada; Department of Health Policy, Management, and Evaluation, University of Toronto (M.K.K., A.M.C.), Ontario, Canada; Institute for Clinical Evaluative Sciences (M.K.K., J.F., J.R.), Toronto, Ontario, Canada; Division of General Internal Medicine and Clinical Epidemiology, and Women’s Health Program, University Health Network (M.K.K, A.M.C.), Toronto, Ontario, Canada; Division of Neurology, University Health Network (F.S., C.J.), Toronto, Ontario, Canada; and Departments of Clinical Neurosciences/Medicine/Community Health Sciences (M.D.H.), University of Calgary, Alberta, Canada. for the Investigators of the Registry of the Canadian Stroke Network
Key words: registries • stroke • women’s health
This article has been cited by other articles:
 |
|
 |
|
  A. Forster, A. Gass, R. Kern, M. E. Wolf, C. Ottomeyer, K. Zohsel, M. Hennerici, and K. Szabo Gender Differences in Acute Ischemic Stroke: Etiology, Stroke Patterns and Response to Thrombolysis Stroke, July 1, 2009; 40(7): 2428 - 2432. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. H. Lichtman, S. B. Jones, E. Watanabe, N. B. Allen, Y. Wang, V. J. Howard, and L. B. Goldstein Elderly Women Have Lower Rates of Stroke, Cardiovascular Events, and Mortality After Hospitalization for Transient Ischemic Attack Stroke, June 1, 2009; 40(6): 2116 - 2122. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
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]
|
|
|
|
|
|
E. Meseguer, M. Mazighi, J. Labreuche, C. Arnaiz, L. Cabrejo, T. Slaoui, C. Guidoux, J.-M. Olivot, H. Abboud, B. Lapergue, et al. Outcomes of Intravenous Recombinant Tissue Plasminogen Activator Therapy According to Gender: A Clinical Registry Study and Systematic Review Stroke, June 1, 2009; 40(6): 2104 - 2110. [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]
|
|
|
|
|
|
R. E. Petrea, A. S. Beiser, S. Seshadri, M. Kelly-Hayes, C. S. Kase, and P. A. Wolf Gender Differences in Stroke Incidence and Poststroke Disability in the Framingham Heart Study Stroke, April 1, 2009; 40(4): 1032 - 1037. [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]
|
|
|
|
|
|
E. M. Stuart-Shor, G. A. Wellenius, D. M. DelloIacono, and M. A. Mittleman Gender Differences in Presenting and Prodromal Stroke Symptoms Stroke, April 1, 2009; 40(4): 1121 - 1126. [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]
|
|
|
|
|
|
G. Saposnik and M. K. Kapral Understanding Stroke in Women: Similar Care, Worse Outcomes? Stroke, March 1, 2009; 40(3): 674 - 675. [Full Text] [PDF]
|
|
|
|
|
|
S. Nagel, P. D. Schellinger, M. Hartmann, E. Juettler, H. B. Huttner, P. Ringleb, S. Schwab, and M. Kohrmann Therapy of Acute Basilar Artery Occlusion: Intraarterial Thrombolysis Alone vs Bridging Therapy Stroke, January 1, 2009; 40(1): 140 - 146. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. A. Sposato, M. M. Esnaola, R. Zamora, M. C. Zurru, O. Fustinoni, G. Saposnik, on behalf of ReNACer Investigators, and the Argentinian Neurological Society Quality of Ischemic Stroke Care in Emerging Countries: The Argentinian National Stroke Registry (ReNACer) Stroke, November 1, 2008; 39(11): 3036 - 3041. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. M. Kent, A. M. Buchan, and M. D. Hill The gender effect in stroke thrombolysis: Of CASES, controls, and treatment-effect modification Neurology, September 30, 2008; 71(14): 1080 - 1083. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. Saposnik, R. Cote, S. Phillips, G. Gubitz, N. Bayer, J. Minuk, S. Black, and for the Stroke Outcome Research Canada (SORCan) Wo Stroke Outcome in Those Over 80: A Multicenter Cohort Study Across Canada Stroke, August 1, 2008; 39(8): 2310 - 2317. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. Saposnik, M. D. Hill, M. O'Donnell, J. Fang, V. Hachinski, M. K. Kapral, and on behalf of the investigators of the Registry of Variables Associated With 7-Day, 30-Day, and 1-Year Fatality After Ischemic Stroke Stroke, August 1, 2008; 39(8): 2318 - 2324. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Arrich, M. Mullner, W. Lalouschek, S. Greisenegger, R. Crevenna, and H. Herkner Influence of Socioeconomic Status and Gender on Stroke Treatment and Diagnostics Stroke, July 1, 2008; 39(7): 2066 - 2072. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. D. Bushnell, J. Lee, P. W. Duncan, L. K. Newby, and L. B. Goldstein Impact of Comorbidities on Ischemic Stroke Outcomes in Women Stroke, July 1, 2008; 39(7): 2138 - 2140. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. M. Reid, D. Dai, G. J. Gubitz, M. K. Kapral, C. Christian, and S. J. Phillips Gender Differences in Stroke Examined in a 10-Year Cohort of Patients Admitted to a Canadian Teaching Hospital Stroke, April 1, 2008; 39(4): 1090 - 1095. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Prabhakaran, C. B. Wright, M. Yoshita, R. Delapaz, T. Brown, C. DeCarli, and R. L. Sacco Prevalence and determinants of subclinical brain infarction: The Northern Manhattan Study Neurology, February 5, 2008; 70(6): 425 - 430. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. W. Gargano, S. Wehner, and M. Reeves Sex Differences in Acute Stroke Care in a Statewide Stroke Registry Stroke, January 1, 2008; 39(1): 24 - 29. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. J. Gray, N. Sprigg, P. M.W. Bath, G. Boysen, P. P. De Deyn, D. Leys, D. O'Neill, E. B. Ringelstein, and for the TAIST Investigators Sex Differences in Quality of Life in Stroke Survivors: Data From the Tinzaparin in Acute Ischaemic Stroke Trial (TAIST) Stroke, November 1, 2007; 38(11): 2960 - 2964. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. Saposnik, A. Baibergenova, M. O'Donnell, M. D. Hill, M. K. Kapral, V. Hachinski, and On behalf of the Stroke Outcome Research Canada (S Hospital volume and stroke outcome: Does it matter? Neurology, September 11, 2007; 69(11): 1142 - 1151. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. W. Gargano, M. J. Reeves, and for the Paul Coverdell National Acute Stroke Regis Sex Differences in Stroke Recovery and Stroke-Specific Quality of Life: Results From a Statewide Stroke Registry Stroke, September 1, 2007; 38(9): 2541 - 2548. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Foerch, B. Misselwitz, M. Humpich, H. Steinmetz, T. Neumann-Haefelin, M. Sitzer, and for the Arbeitsgruppe Schlaganfall Hessen Sex Disparity in the Access of Elderly Patients to Acute Stroke Care Stroke, July 1, 2007; 38(7): 2123 - 2126. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Hodgson, P. Lindsay, and F. Rubini Can Mass Media Influence Emergency Department Visits for Stroke? Stroke, July 1, 2007; 38(7): 2115 - 2122. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N. E. Mayo, L. Nadeau, S. S. Daskalopoulou, and R. Cote The evolution of stroke in Quebec: A 15-year perspective Neurology, April 3, 2007; 68(14): 1122 - 1127. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Arnold, L. Kappeler, K. Nedeltchev, C. Brekenfeld, U. Fischer, B. Keserue, L. Remonda, G. Schroth, and H. P. Mattle Recanalization and Outcome After Intra-Arterial Thrombolysis in Middle Cerebral Artery and Internal Carotid Artery Occlusion: Does Sex Matter? Stroke, April 1, 2007; 38(4): 1281 - 1285. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M.S.V. Elkind, S. Prabhakaran, J. Pittman, W. Koroshetz, M. Jacoby, K. C. Johnston, and for the GAIN Americas Investigators Sex as a predictor of outcomes in patients treated with thrombolysis for acute stroke Neurology, March 13, 2007; 68(11): 842 - 848. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. Carandang, S. Seshadri, A. Beiser, M. Kelly-Hayes, C. S. Kase, W. B. Kannel, and P. A. Wolf Trends in Incidence, Lifetime Risk, Severity, and 30-Day Mortality of Stroke Over the Past 50 Years JAMA, December 27, 2006; 296(24): 2939 - 2946. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. M. Kent and M. D. Hill Differences in Response to Reperfusion Therapies in Acute Stroke Between Men and Women: Mediated by Sex or by Chance? Stroke, December 1, 2006; 37(12): 2878 - 2879. [Full Text] [PDF]
|
|
|
|
|
|
S. Paolucci, M. Bragoni, P. Coiro, D. De Angelis, F. R. Fusco, D. Morelli, V. Venturiero, and L. Pratesi Is Sex a Prognostic Factor in Stroke Rehabilitation?: A Matched Comparison Stroke, December 1, 2006; 37(12): 2989 - 2994. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. D. Hill, D. M. Kent, J. Hinchey, H. Rowley, A. M. Buchan, L. R. Wechsler, R. T. Higashida, N. J. Fischbein, W. P. Dillon, M. Gent, et al. Sex-Based Differences in the Effect of Intra-Arterial Treatment of Stroke: Analysis of the PROACT-2 Study Stroke, September 1, 2006; 37(9): 2322 - 2325. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. M. Kent, M. D. Hill, S. I. Savitz, and M. Selim Gender Differences in tPA-Related Arterial Recanalization * Response: Stroke, December 1, 2005; 36(12): 2529 - 2530. [Full Text] [PDF]
|
|