Biological sex-dependent differences in acute and post-acute stroke care—a population-based case–control study

Abstract Introduction Observed disparities in stroke care between the biological sexes are based on observational data from stroke centres or focus on single aspects of stroke care. Hence, we offer a comprehensive analysis encapsulating the entire stroke treatment path. Patients and methods The quality-controlled, population-based Tyrolean Stroke Care pathway, recording all ischemic stroke cases in the entire federal state independent of treating hospital or department, was applied. Data from all patients (2019-2023) were analysed, which encompass information from stroke call activation to the time of recurrent stroke associated re-hospitalisation. Results 5733 ischemic stroke cases (men/women 56.0%/44.0%) were recorded with an incidence of first ever stroke of 133/100,000 inhabitants. Men were numerically more likely to suffer a stroke during that time period (149 vs 118/100,000 respectively). After adjusting for age, National Institute of Stroke Scale, and the pre-stroke modified Rankin Scale, no differences in pre-hospital stroke care, post-stroke rehabilitation access as well as most in-hospital metrics were seen. Still, women were less likely to be admitted to stroke units (odds ratio OR 0.89 0.80, 1.00) and less frequently underwent MRI (OR 0.85 0.74, 0.96) or echocardiography (OR 0.85 0.76, 0.96) during their hospital stay. However, women less frequently suffered serious post-stroke in-house complications (OR 0.80 0.66, 0.97). Upon follow-up, men had higher rates of all cause-mortality (OR 0.81 0.69, 0.94) as well as recurrent stroke-related re-admission (OR 0.63 0.48, 0.83). Conclusion Within a highly structured and quality-controlled stroke care pathway, disparities in stroke care between sexes are low. Differences exist in terms of diagnostic algorithms, post-stroke mortality and recurrent stroke-related re-admissions, which merit further research.