OBJECTIVE: To examine factors contributing to the sex differences in functional outcomes and participation restriction after stroke.
METHODS: 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.
RESULTS: 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).
CONCLUSIONS: 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.
BT - Neurology C1 - https://www.ncbi.nlm.nih.gov/pubmed/29703773?dopt=Abstract DO - 10.1212/WNL.0000000000005602 IS - 22 J2 - Neurology LA - eng N2 -OBJECTIVE: To examine factors contributing to the sex differences in functional outcomes and participation restriction after stroke.
METHODS: 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.
RESULTS: 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).
CONCLUSIONS: 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.
PY - 2018 SP - e1945 EP - e1953 T2 - Neurology TI - Factors contributing to sex differences in functional outcomes and participation after stroke. VL - 90 SN - 1526-632X ER -