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(Stroke. 2009;40:1134.)
© 2009 American Heart Association, Inc.

Go Red for Women

Sex-Related Differences in Quality of Care and Short-Term Mortality Among Patients With Acute Stroke in Denmark

A Nationwide Follow-Up Study

Kaare D. Palnum, MD; Grethe Andersen, MD, Dr Med Sci; Annette Ingeman, MHSc; Birgitte R. Krog, MPH; Paul Bartels, MD Søren P. Johnsen, MD, PhD

From the Department of Clinical Epidemiology (K.D.P., S.P.J.), Aarhus University Hospital, Denmark; the Department of Neurology (G.A.), Aarhus University Hospital, Aarhus Hospital, Denmark; and the Coordinating Secretariat (NIP) (A.I., B.R.K., P.B.), County of Aarhus, Denmark.

Correspondence to Kaare D Palnum, Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, 8200 Aarhus N, Denmark. E-mail kdp{at}dce.au.dk

Background and Purpose— Sex may predict level of care and successive outcome among patients with stroke. We examined fulfillment of quality of care criteria according to sex and possible impact of any sex-related differences on short-term mortality in a population-based nationwide follow-up study in Denmark.

Methods— We identified 29 549 patients admitted with stroke between January 2003 and October 2005 in the Danish National Indicator Project. Data on 30- and 90-day mortality were obtained from The Civil Registration System. We compared proportions of patients receiving adequate care between sexes, as measured by admission to a specialized stroke unit, administration of antiplatelet or anticoagulant therapy, examination with CT/MRI scan, and assessment by a physiotherapist, an occupational therapist, and of nutritional risk. Further, we computed 30- and 90-day mortality rate ratios (MRR), adjusted for patient characteristics, fulfillment of quality of care criteria, and department.

Results— The proportion of patients who received adequate care was either slightly lower or similar among women when compared to men. The relative risks (RR) of receiving specific components of care ranged from 0.84 (95% confidence interval [CI]:0.74 to 0.96) to 1.01 (95% CI:0.96 to 1.06) when comparing sexes. The adjusted mortality rate ratios were lower among women and adjustment for fulfillment of quality of care criteria had only marginal impact.

Conclusions— There appear not to be any substantial sex-related differences in acute hospital care among patients with stroke in Denmark. The lower female short-term mortality is therefore most likely explained by other factors.

Key Words: quality of care • prognosis • sex • stroke