@article{23469,
  author = {Anderson Craig and Heeley Emma and Cadilhac Dominique and Thrift Amanda and Gall Seana and Otahal Petr and Feigin Valery and Rothwell Peter and Barker-Collo Suzanne and Phan Hoang and Blizzard Christopher and Reeves Mathew and Sturm Jonathan and Vemmos Konstantinos and Parmar Priya and Krishnamurthi Rita and Bejot Yannick and Cabral Norberto and Carolei Antonio and Sacco Simona and Chausson Nicolas and Olindo Stephane and Silva Carolina and Correia Manuel and Magalhães Rui and Appelros Peter and Kõrv Janika and Vibo Riina and Minelli Cesar},
  title = {Factors contributing to sex differences in functional outcomes and participation after stroke.},
  abstract = {<p><b>OBJECTIVE: </b>To examine factors contributing to the sex differences in functional outcomes and participation restriction after stroke.</p><p><b>METHODS: </b>Individual participant data on long-term functional outcome or participation restriction (i.e., handicap) were obtained from 11 stroke incidence studies (1993-2014). Multivariable log-binomial regression was used to estimate the female:male relative risk (RR) of poor functional outcome (modified Rankin Scale score >2 or Barthel Index score <20) at 1 year (10 studies, n = 4,852) and 5 years (7 studies, n = 2,226). Multivariable linear regression was used to compare the mean difference (MD) in participation restriction by use of the London Handicap Scale (range 0-100 with lower scores indicating poorer outcome) for women compared to men at 5 years (2 studies, n = 617). For each outcome, study-specific estimates adjusted for confounding factors (e.g., sociodemographics, stroke-related factors) were combined with the use of random-effects meta-analysis.</p><p><b>RESULTS: </b>In unadjusted analyses, women experienced worse functional outcomes after stroke than men (1 year: pooled RR 1.32, 95% confidence interval [CI] 1.18-1.48; 5 years: RR 1.31, 95% CI 1.16-1.47). However, this difference was greatly attenuated after adjustment for age, prestroke dependency, and stroke severity (1 year: RR 1.08, 95% CI 0.97-1.20; 5 years: RR 1.05, 95% CI 0.94-1.18). Women also had greater participation restriction than men (pooled MD -5.55, 95% CI -8.47 to -2.63), but this difference was again attenuated after adjustment for the aforementioned factors (MD -2.48, 95% CI -4.99 to 0.03).</p><p><b>CONCLUSIONS: </b>Worse outcomes after stroke among women were explained mostly by age, stroke severity, and prestroke dependency, suggesting these potential targets to improve the outcomes after stroke in women.</p>},
  year = {2018},
  journal = {Neurology},
  volume = {90},
  pages = {e1945-e1953},
  issn = {1526-632X},
  doi = {10.1212/WNL.0000000000005602},
  language = {eng},
}