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February 18, 2020Frontiers in NeurologyOpen Access

Sex Differences in Long-Term Mortality and Functional Outcome After Rehabilitation in Patients With Severe Stroke

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Key result

Among patients with severe stroke admitted to inpatient rehabilitation, women had a 27% lower adjusted 3-year risk of death compared with men (HR 0.73).

Why the study?

Sex differences in outcomes among patients with severe stroke admitted to inpatient rehabilitation had not been established.

Does female sex compared to male sex improve long-term mortality and functional outcomes in patients with severe stroke undergoing inpatient rehabilitation?

Population

1,316 patients aged 18 to 99 with severe stroke admitted to inpatient rehabilitation

Comparison

Women vs men

Design

Cohort study

Follow-up

3 years

Authors

DSDomenico ScrutinioPBPetronilla BattistaPGPietro Guida

Discussion

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Member takes

Overview

Women had lower adjusted long-term mortality after severe stroke rehabilitation than men; observational data leave open whether this reflects causal sex differences or residual confounding.

Study Design

Type

Cohort (n=1,316)

Multicenter

Yes

Structured PICO

Does female sex compared to male sex improve long-term mortality and functional outcomes in patients with severe stroke undergoing inpatient rehabilitation?

P
Population
1,316 patients aged 18 to 99 (mean 72) with severe stroke admitted to inpatient rehabilitation ≤90 days from stroke occurrence, classified as case-mix groups 0108, 0109, and 0110 of the Medicare case-mix classification system.
I
Intervention
Female sex (observational exposure)
C
Comparator
Male sex
O
Outcome
Three-year all-cause mortality from admission to rehabilitationhard clinical

Main Result

Effect estimate: HR 0.73 (95% CI 0.56-0.96)

Absolute Event Rate: 20.7% vs 22%

p-value: p=0.025

Among patients with severe stroke admitted to inpatient rehabilitation, women had a significantly lower adjusted 3-year mortality risk compared to men, though functional recovery and short-term outcomes were similar.

Limitations

  • Hospital-based data may be prone to selection bias
  • Potential age-related selection bias as oldest old patients are less likely to undergo inpatient rehabilitation
  • Stepwise methods for covariate selection may overestimate exposure effects and underestimate statistical uncertainty
  • Retrospective design did not allow accounting for unmeasured confounders such as premorbid functional status
  • Some covariates in the multivariable models could be intermediates on the causal pathway rather than confounders
  • Did not examine the prognostic role of neuroimaging
  • Could not assess the specific causes of death
  • Unmeasured potential confounding factors may affect hazard estimates
  • A large proportion of interindividual variability in functional outcome remains unexplained

Cite This Study

Scrutinio et al. (2020) conducted a cohort in Severe stroke (n=1,316). Female sex vs. Male sex was evaluated on 3-year all-cause mortality (HR 0.73, 95% CI 0.56-0.96, p=0.025). Among patients with severe stroke admitted to inpatient rehabilitation, women had a 27% lower adjusted 3-year risk of death compared with men (HR 0.73).

synapsesocial.com/papers/6a110ce4bcb015a4461a142ahttps://doi.org/10.3389/fneur.2020.00084
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Sex differences in stroke outcomes: a retrospective analysis2025
  2. 2Sex Differences in Management and Outcome After Stroke2003 · 330 citations
  3. 3Sex disparities in comorbidities, one-year functional outcome and mortality after ischemic stroke: a population-based study.2026
  4. 4Sex Differences in Mortality and Functional Outcomes Across Stroke Subtype: A Nationwide Cohort Study2026
  5. 5Sex Differences in Patient-Reported Poststroke Disability2017