Women experience worse outcomes after
stroke than men despite their lower age-adjusted incidence of stroke. Previous
reviews of sex differences in select stroke outcomes, including activity
limitations, participation restriction, poststroke depression (PSD), and
health-related quality of life (HRQoL), 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. 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.
Methods
Full details of our methods are provided
in the online-only Data Supplement. A previous review included studies up to
2007, 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. Full results tables are shown in the online-only Data Supplement.
Results
Activity Limitations
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). In multivariable adjusted analyses, women had worse outcome than
men with significantly lower odds of good outcome (OR range: 0.37–0.75).
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