Focused Update of Sex Differences in Patient Reported Outcome Measures After Stroke
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Women experience worse outcomes after stroke than men1 despite their lower age-adjusted incidence of stroke.2 Previous reviews of sex differences in select stroke outcomes, including activity limitations,3–5 participation restriction,4 poststroke depression (PSD),3 and health-related quality of life (HRQoL),3,4 demonstrated that women had worse outcomes than men across many of these measures. Women’s greater age and stroke severity, as well as poorer prestroke function, seem to contribute to the sex difference in outcomes, but data on other contributing factors are limited.4 Existing reviews included studies published >5 years ago, and given the rapid increase in the number of studies addressing sex differences in stroke outcomes, an updated review is warranted.
Full details of our methods are provided in the online-only Data Supplement. A previous review included studies up to 2007,3 so we reviewed studies from 2007 onwards that examined sex differences in patient reported outcome measures (PROMs) at ≤12 months after stroke, including activity limitations, HRQoL, participation restriction, impaired cognition, and mood.6 Full results tables are shown in the online-only Data Supplement.
Of 1875 articles identified, 22 studies (3 population based) that were designed to examine sex differences (Results and Table I in the online-only Data Supplement) met criteria for inclusion. The most common instrument to assess activity limitations was the modified Rankin Scale, followed by the Barthel Index.
In 8 studies including ischemic and hemorrhagic strokes, unadjusted estimates showed that women had more activity limitations than men through significantly lower odds of good outcome (odds ratio [OR] range: 0.44–0.61)7–9 or greater odds of poor outcome (OR range: 1.29–1.62).10–14 In multivariable adjusted analyses, women had worse outcome than men with significantly lower odds of good outcome (OR range: 0.37–0.75) or …