Introduction: As the management of intracerebral haemorrhage (ICH) shifts from historical inertia to more proactive, evidence-based care, ensuring sex equitable access to best-practice stroke care is increasingly important. Data on sex differences in access to care for ICH remains limited and often conflicting. More robust evidence is required to understand where disparities may exist to inform targeted interventions. Aims: We aimed to determine sex differences in the clinical and surgical management of patients with acute ICH who participated in the third Intensive Blood Pressure Reduction in Acute Cerebral Haemorrhage Trial (INTERACT3). Methods: We performed a post hoc analysis of INTERACT3, an international stepped wedge, cluster randomised trial undertaken in 121 hospitals across 9 low-to-middle income countries and 1 high-income country. The trial aimed to evaluate a care bundle comprised of intensive blood pressure lowering, rapid correction of hyperglycaemia, fever control, and reversal of anticoagulation; in adults presenting within 6 hours of ICH onset. We used mixed-effects logistic regression to evaluate sex differences in access to surgical interventions, admission to an intensive care unit or acute stroke unit, assisted feeding, physiotherapy, occupational therapy, withdrawal of care, and use of pharmacological therapies (antiepileptic drugs, mannitol, dexamethasone, and statins). Patterns of care were further evaluated using latent class analysis, with sex differences analysed using the same regression framework. Results: Of 7,036 patients with ICH, 2,533 (36%) were female. Females were older and had more severe neurological deficits. Overall care provision was similar across sexes. However, females were more likely to receive assisted feeding (odds ratioOR 1.15, 95%CI 1.02-1.31), and were less likely to withdraw from active care (OR 0.41, 95%CI 0.19-0.87) than males. Surgical interventions were accessed at similar rates among sexes, a finding that persisted in analyses restricted to supratentorial ICH with haematoma volumes ≥30 mL. Three distinct care classes were identified: high intensity, high rehabilitation, and low intensity, with females and males having comparable distributions within the classes. Conclusion: Following acute ICH, females generally receive similar active acute care interventions as males, with the exception of observed differences in access to assisted feeding and decision to withdraw from active care. These findings suggest that equal access to ICH interventions for females and males is feasible and exists in some settings. However, disparities in certain key interventions remain and present actionable opportunities for improvement. Further research is needed to explore not only access, but also the timing and frequency of these interventions. Data access statement: Individual, de-identified participant data used in these analyses will be shared on request from any qualified investigator after the approval of a protocol and signed data access agreement via both the trial steering committee and the research office of The George Institute for Global Health (Sydney, NSW, Australia).
Allende et al. (Thu,) studied this question.