What is the clinical evidence from this study?

Study design: Cohort. Population: Stroke (n=2725). Intervention: Female gender vs. Male gender. Primary outcome: Treatment with tissue plasminogen activator (OR 0.51, 95% CI 0.35-0.72).

February 22, 2008Open Access

Gender Differences in Stroke Examined in a 10-Year Cohort of Patients Admitted to a Canadian Teaching Hospital

Key Result

After adjusting for confounding factors, women with stroke were significantly less likely than men to be treated with tissue plasminogen activator (OR 0.51; 95% CI 0.35-0.72).

Study Design

Type

Cohort (n=2,725)

Multicenter

Structured PICO

Are gender differences in the investigation, treatment, and outcome of stroke due to confounding factors?

Population

2,725 consecutive hospitalized stroke patients (48% women) admitted to a Canadian teaching hospital between 1996 and 2006.

Exposure

Female gender

Comparator

Male gender

Outcome

Gender differences in the use of investigations, trial enrollment, treatment with intravenous tissue plasminogen activator, and in-hospital outcomes

While many gender differences in stroke care are explained by confounding factors, women remain significantly less likely to receive thrombolytic therapy even after adjustment.

Main Result

Odds Ratio: 0.51 (95% CI 0.35–0.72)

Abstract

BACKGROUND AND PURPOSE: Studies suggest that women with stroke are investigated less aggressively and receive tissue plasminogen activator less frequently than men. We tested whether gender differences in the investigation, treatment, and outcome of stroke are due to confounding factors. METHODS: Gender differences in the use of investigations, trial enrollment, treatment with intravenous tissue plasminogen activator, and in-hospital outcomes were examined in data from our prospective registry using multivariate analysis to adjust for age, prestroke functional status, stroke subtype and severity, and atrial fibrillation. RESULTS: Of 2725 consecutive hospitalized patients (1996 to 2006), 88% had ischemic stroke and 48% were women. Women were older (median age, 77 versus 70 years), had more severe strokes, and were less likely to be independent prestroke (78% versus 87%) compared with men (all Por=80 years, increased significantly between 1996 to 1997 and 2005 to 2006. After adjustment for confounding, women were less likely to have infratentorial strokes (OR, 0.78; 95% CI, 0.62 to 0.97), be able to walk unaided on admission (OR, 0.69; 95% CI, 0.54 to 0.87), be treated with tissue plasminogen activator (OR, 0.51; 95% CI, 0.35 to 0.72), experience pneumonia (OR, 0.38; 95% CI, 0.26 to 0.55), achieve a discharge Barthel Index of >or=95 (OR, 0.75; 95% CI, 0.61 to 0.94, and were more likely to experience a urinary tract infection (OR, 2.06; 95% CI, 1.61 to 2.64). There was no gender difference in adjusted use of investigations. CONCLUSIONS: The majority of the gender differences in stroke were explained by confounding. More research is required to understand gender differences in stroke pathophysiology and the utilization of thrombolytic therapy.