Abstract 2208: Sex Differences in Ischemic Stroke Mortality
Introduction---Stroke is becoming increasingly more prevalent in women. Prior studies of sex differences in stroke mortality have reported variable findings. Although crude stroke fatality is higher in women, this appears to be mediated by age and other baseline differences. We hypothesized that no differences existed between genders in in-hospital and longer term mortality, as well as in cause of death, after stroke admission.
Methods---We used the Myocardial Infarction Data Acquisition System (MIDAS) database, which includes demographic and clinical data on patients discharged with a primary diagnosis of cerebral infarction from all non-federal acute care hospitals in New Jersey between 1996 and 2007. Out-of-hospital deaths were assessed by matching MIDAS records with New Jersey death registration files. In-hospital, 1-year, and interval (discharge to 1-year) mortality were calculated. Total, cardiovascular disease (CVD), and non-CVD mortality were calculated. Multivariate logistic and Cox regression models were used to measure the effect of sex on in-hospital, 1-year, and interval mortality after adjusting for demographics, comorbidities, hospital type, year of admission, and treatment. Statistical significance was defined as a P-value ≤ 0.01.
Results---134,441 patients (54.8% female) were admitted with a primary diagnosis of cerebral infarction during the study period. Women were on average 5.1 years older than men. Although the average Charlson Index was lower for women, hypertension, atrial fibrillation, congestive heart failure, dementia, and connective tissue disorders were all more common (p<0.0001). Women were significantly less likely to be treated with intravenous tPA than men (OR = 0.81; 95% CI = 0.73 to 0.89). In-hospital and 1-year mortality rates were 9.3% and 27.2% for women and 8.0% and 22.6% for men. After adjusting for available covariates, women had significantly higher in-hospital (OR = 1.04; 95% CI = 1.01 to 1.09) and 1-year (HR = 1.03; 95% CI = 1.01 to 1.05) mortality than men. Comparisons of in-hospital and interval CVD and non-CVD death rates are presented in the Figure.
Conclusion---Adjusted in-hospital and 1-year mortality was significantly higher for women than men hospitalized for a first ischemic stroke in New Jersey. This excess in morality appears to be driven by significant differences in non-CVD related in-hospital deaths in women. Women were also less likely to receive IV tPA then men after adjusting for available covariates.
- © 2012 by American Heart Association, Inc.