May 29, 2018; 90 (22) Article
Factors contributing to sex differences in functional outcomes and participation after stroke
Hoang T. Phan, Christopher L. Blizzard, Mathew J. Reeves, Amanda G. Thrift, Dominique A. Cadilhac, Jonathan Sturm, Emma Heeley, Petr Otahal, Konstantinos Vemmos, Craig Anderson, Priya Parmar, Rita Krishnamurthi, Suzanne Barker-Collo, Valery Feigin, Yannick Bejot, Norberto Luiz Cabral, Antonio Carolei, Simona Sacco, Nicolas Chausson, Stephane Olindo, Peter Rothwell, Carolina Silva, Manuel Correia, Rui Magalhães, Peter Appelros, Janika Kõrv, Riina Vibo, Cesar Minelli, Seana L. Gall
First published April 27, 2018, DOI: https://doi.org/10.1212/WNL.0000000000005602
Hoang T. Phan
From the Menzies Institute for Medical Research Tasmania (H.T.P., C.L.B., P.O., S.L.G.), University of Tasmania, Hobart, Australia; Department of Health Management and Health Economics (H.T.P.), Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam; Department of Epidemiology and Biostatistics (M.J.R.), Michigan State University, East Lansing; Department of Medicine (A.G.T., D.A.C.), School of Clinical Sciences at Monash Health, Monash University, Clayton; Florey Institute Neuroscience and Mental Health (D.A.C.), Heidelberg, University of Melbourne, Victoria; Faculty of Health and Medicine (J.S.), University of Newcastle; George Institute for Global Health (E.H., C.A.), University of Sydney, New South Wales, Australia; Hellenic Cardiovascular Research Society (K.V.), Athens, Greece; National Institute for Stroke and Applied Neurosciences (P.P., R.K., V.F.), School of Public Health and Psychosocial Studies, Auckland University of Technology; School of Psychology (S.B.-C.), University of Auckland, New Zealand; University of Burgundy (Y.B.), University Hospital of Dijon, France; Clinica Neurológica de Joinville (N.L.C.), Joinville Stroke Registry, University of Joinville Region, Brazil; Department of Biotechnological and Applied Clinical Sciences (A.C., S.S.), Neurological Institute, University of L'Aquila, Italy; Stroke Unit (N.C.), Centre Hospitalier Sud Francilien, Corbeil-Essonnes; Stroke Unit (S.O.), University Hospital of Bordeaux, France; Stroke Prevention Research Unit (P.R.), Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK; UNIFAI (C.S., M.C., R.M.), Instituto de Ciências Biomédicas de Abel Salazar, Universidade do Porto, Portugal; Department of Neurology (P.A.), Faculty of Medicine and Health, Örebro University, Sweden; Department of Neurology and Neurosurgery (J.K., R.V.), University of Tartu, Estonia; and Hospital Carlos Fernando Malzoni and Neurologic Center of Research and Rehabilitation (C.M.), Matão, SP, Brazil.
Christopher L. Blizzard
From the Menzies Institute for Medical Research Tasmania (H.T.P., C.L.B., P.O., S.L.G.), University of Tasmania, Hobart, Australia; Department of Health Management and Health Economics (H.T.P.), Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam; Department of Epidemiology and Biostatistics (M.J.R.), Michigan State University, East Lansing; Department of Medicine (A.G.T., D.A.C.), School of Clinical Sciences at Monash Health, Monash University, Clayton; Florey Institute Neuroscience and Mental Health (D.A.C.), Heidelberg, University of Melbourne, Victoria; Faculty of Health and Medicine (J.S.), University of Newcastle; George Institute for Global Health (E.H., C.A.), University of Sydney, New South Wales, Australia; Hellenic Cardiovascular Research Society (K.V.), Athens, Greece; National Institute for Stroke and Applied Neurosciences (P.P., R.K., V.F.), School of Public Health and Psychosocial Studies, Auckland University of Technology; School of Psychology (S.B.-C.), University of Auckland, New Zealand; University of Burgundy (Y.B.), University Hospital of Dijon, France; Clinica Neurológica de Joinville (N.L.C.), Joinville Stroke Registry, University of Joinville Region, Brazil; Department of Biotechnological and Applied Clinical Sciences (A.C., S.S.), Neurological Institute, University of L'Aquila, Italy; Stroke Unit (N.C.), Centre Hospitalier Sud Francilien, Corbeil-Essonnes; Stroke Unit (S.O.), University Hospital of Bordeaux, France; Stroke Prevention Research Unit (P.R.), Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK; UNIFAI (C.S., M.C., R.M.), Instituto de Ciências Biomédicas de Abel Salazar, Universidade do Porto, Portugal; Department of Neurology (P.A.), Faculty of Medicine and Health, Örebro University, Sweden; Department of Neurology and Neurosurgery (J.K., R.V.), University of Tartu, Estonia; and Hospital Carlos Fernando Malzoni and Neurologic Center of Research and Rehabilitation (C.M.), Matão, SP, Brazil.
Mathew J. Reeves
From the Menzies Institute for Medical Research Tasmania (H.T.P., C.L.B., P.O., S.L.G.), University of Tasmania, Hobart, Australia; Department of Health Management and Health Economics (H.T.P.), Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam; Department of Epidemiology and Biostatistics (M.J.R.), Michigan State University, East Lansing; Department of Medicine (A.G.T., D.A.C.), School of Clinical Sciences at Monash Health, Monash University, Clayton; Florey Institute Neuroscience and Mental Health (D.A.C.), Heidelberg, University of Melbourne, Victoria; Faculty of Health and Medicine (J.S.), University of Newcastle; George Institute for Global Health (E.H., C.A.), University of Sydney, New South Wales, Australia; Hellenic Cardiovascular Research Society (K.V.), Athens, Greece; National Institute for Stroke and Applied Neurosciences (P.P., R.K., V.F.), School of Public Health and Psychosocial Studies, Auckland University of Technology; School of Psychology (S.B.-C.), University of Auckland, New Zealand; University of Burgundy (Y.B.), University Hospital of Dijon, France; Clinica Neurológica de Joinville (N.L.C.), Joinville Stroke Registry, University of Joinville Region, Brazil; Department of Biotechnological and Applied Clinical Sciences (A.C., S.S.), Neurological Institute, University of L'Aquila, Italy; Stroke Unit (N.C.), Centre Hospitalier Sud Francilien, Corbeil-Essonnes; Stroke Unit (S.O.), University Hospital of Bordeaux, France; Stroke Prevention Research Unit (P.R.), Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK; UNIFAI (C.S., M.C., R.M.), Instituto de Ciências Biomédicas de Abel Salazar, Universidade do Porto, Portugal; Department of Neurology (P.A.), Faculty of Medicine and Health, Örebro University, Sweden; Department of Neurology and Neurosurgery (J.K., R.V.), University of Tartu, Estonia; and Hospital Carlos Fernando Malzoni and Neurologic Center of Research and Rehabilitation (C.M.), Matão, SP, Brazil.
Amanda G. Thrift
From the Menzies Institute for Medical Research Tasmania (H.T.P., C.L.B., P.O., S.L.G.), University of Tasmania, Hobart, Australia; Department of Health Management and Health Economics (H.T.P.), Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam; Department of Epidemiology and Biostatistics (M.J.R.), Michigan State University, East Lansing; Department of Medicine (A.G.T., D.A.C.), School of Clinical Sciences at Monash Health, Monash University, Clayton; Florey Institute Neuroscience and Mental Health (D.A.C.), Heidelberg, University of Melbourne, Victoria; Faculty of Health and Medicine (J.S.), University of Newcastle; George Institute for Global Health (E.H., C.A.), University of Sydney, New South Wales, Australia; Hellenic Cardiovascular Research Society (K.V.), Athens, Greece; National Institute for Stroke and Applied Neurosciences (P.P., R.K., V.F.), School of Public Health and Psychosocial Studies, Auckland University of Technology; School of Psychology (S.B.-C.), University of Auckland, New Zealand; University of Burgundy (Y.B.), University Hospital of Dijon, France; Clinica Neurológica de Joinville (N.L.C.), Joinville Stroke Registry, University of Joinville Region, Brazil; Department of Biotechnological and Applied Clinical Sciences (A.C., S.S.), Neurological Institute, University of L'Aquila, Italy; Stroke Unit (N.C.), Centre Hospitalier Sud Francilien, Corbeil-Essonnes; Stroke Unit (S.O.), University Hospital of Bordeaux, France; Stroke Prevention Research Unit (P.R.), Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK; UNIFAI (C.S., M.C., R.M.), Instituto de Ciências Biomédicas de Abel Salazar, Universidade do Porto, Portugal; Department of Neurology (P.A.), Faculty of Medicine and Health, Örebro University, Sweden; Department of Neurology and Neurosurgery (J.K., R.V.), University of Tartu, Estonia; and Hospital Carlos Fernando Malzoni and Neurologic Center of Research and Rehabilitation (C.M.), Matão, SP, Brazil.
Dominique A. Cadilhac
From the Menzies Institute for Medical Research Tasmania (H.T.P., C.L.B., P.O., S.L.G.), University of Tasmania, Hobart, Australia; Department of Health Management and Health Economics (H.T.P.), Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam; Department of Epidemiology and Biostatistics (M.J.R.), Michigan State University, East Lansing; Department of Medicine (A.G.T., D.A.C.), School of Clinical Sciences at Monash Health, Monash University, Clayton; Florey Institute Neuroscience and Mental Health (D.A.C.), Heidelberg, University of Melbourne, Victoria; Faculty of Health and Medicine (J.S.), University of Newcastle; George Institute for Global Health (E.H., C.A.), University of Sydney, New South Wales, Australia; Hellenic Cardiovascular Research Society (K.V.), Athens, Greece; National Institute for Stroke and Applied Neurosciences (P.P., R.K., V.F.), School of Public Health and Psychosocial Studies, Auckland University of Technology; School of Psychology (S.B.-C.), University of Auckland, New Zealand; University of Burgundy (Y.B.), University Hospital of Dijon, France; Clinica Neurológica de Joinville (N.L.C.), Joinville Stroke Registry, University of Joinville Region, Brazil; Department of Biotechnological and Applied Clinical Sciences (A.C., S.S.), Neurological Institute, University of L'Aquila, Italy; Stroke Unit (N.C.), Centre Hospitalier Sud Francilien, Corbeil-Essonnes; Stroke Unit (S.O.), University Hospital of Bordeaux, France; Stroke Prevention Research Unit (P.R.), Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK; UNIFAI (C.S., M.C., R.M.), Instituto de Ciências Biomédicas de Abel Salazar, Universidade do Porto, Portugal; Department of Neurology (P.A.), Faculty of Medicine and Health, Örebro University, Sweden; Department of Neurology and Neurosurgery (J.K., R.V.), University of Tartu, Estonia; and Hospital Carlos Fernando Malzoni and Neurologic Center of Research and Rehabilitation (C.M.), Matão, SP, Brazil.
Jonathan Sturm
From the Menzies Institute for Medical Research Tasmania (H.T.P., C.L.B., P.O., S.L.G.), University of Tasmania, Hobart, Australia; Department of Health Management and Health Economics (H.T.P.), Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam; Department of Epidemiology and Biostatistics (M.J.R.), Michigan State University, East Lansing; Department of Medicine (A.G.T., D.A.C.), School of Clinical Sciences at Monash Health, Monash University, Clayton; Florey Institute Neuroscience and Mental Health (D.A.C.), Heidelberg, University of Melbourne, Victoria; Faculty of Health and Medicine (J.S.), University of Newcastle; George Institute for Global Health (E.H., C.A.), University of Sydney, New South Wales, Australia; Hellenic Cardiovascular Research Society (K.V.), Athens, Greece; National Institute for Stroke and Applied Neurosciences (P.P., R.K., V.F.), School of Public Health and Psychosocial Studies, Auckland University of Technology; School of Psychology (S.B.-C.), University of Auckland, New Zealand; University of Burgundy (Y.B.), University Hospital of Dijon, France; Clinica Neurológica de Joinville (N.L.C.), Joinville Stroke Registry, University of Joinville Region, Brazil; Department of Biotechnological and Applied Clinical Sciences (A.C., S.S.), Neurological Institute, University of L'Aquila, Italy; Stroke Unit (N.C.), Centre Hospitalier Sud Francilien, Corbeil-Essonnes; Stroke Unit (S.O.), University Hospital of Bordeaux, France; Stroke Prevention Research Unit (P.R.), Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK; UNIFAI (C.S., M.C., R.M.), Instituto de Ciências Biomédicas de Abel Salazar, Universidade do Porto, Portugal; Department of Neurology (P.A.), Faculty of Medicine and Health, Örebro University, Sweden; Department of Neurology and Neurosurgery (J.K., R.V.), University of Tartu, Estonia; and Hospital Carlos Fernando Malzoni and Neurologic Center of Research and Rehabilitation (C.M.), Matão, SP, Brazil.
Emma Heeley
From the Menzies Institute for Medical Research Tasmania (H.T.P., C.L.B., P.O., S.L.G.), University of Tasmania, Hobart, Australia; Department of Health Management and Health Economics (H.T.P.), Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam; Department of Epidemiology and Biostatistics (M.J.R.), Michigan State University, East Lansing; Department of Medicine (A.G.T., D.A.C.), School of Clinical Sciences at Monash Health, Monash University, Clayton; Florey Institute Neuroscience and Mental Health (D.A.C.), Heidelberg, University of Melbourne, Victoria; Faculty of Health and Medicine (J.S.), University of Newcastle; George Institute for Global Health (E.H., C.A.), University of Sydney, New South Wales, Australia; Hellenic Cardiovascular Research Society (K.V.), Athens, Greece; National Institute for Stroke and Applied Neurosciences (P.P., R.K., V.F.), School of Public Health and Psychosocial Studies, Auckland University of Technology; School of Psychology (S.B.-C.), University of Auckland, New Zealand; University of Burgundy (Y.B.), University Hospital of Dijon, France; Clinica Neurológica de Joinville (N.L.C.), Joinville Stroke Registry, University of Joinville Region, Brazil; Department of Biotechnological and Applied Clinical Sciences (A.C., S.S.), Neurological Institute, University of L'Aquila, Italy; Stroke Unit (N.C.), Centre Hospitalier Sud Francilien, Corbeil-Essonnes; Stroke Unit (S.O.), University Hospital of Bordeaux, France; Stroke Prevention Research Unit (P.R.), Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK; UNIFAI (C.S., M.C., R.M.), Instituto de Ciências Biomédicas de Abel Salazar, Universidade do Porto, Portugal; Department of Neurology (P.A.), Faculty of Medicine and Health, Örebro University, Sweden; Department of Neurology and Neurosurgery (J.K., R.V.), University of Tartu, Estonia; and Hospital Carlos Fernando Malzoni and Neurologic Center of Research and Rehabilitation (C.M.), Matão, SP, Brazil.
Petr Otahal
From the Menzies Institute for Medical Research Tasmania (H.T.P., C.L.B., P.O., S.L.G.), University of Tasmania, Hobart, Australia; Department of Health Management and Health Economics (H.T.P.), Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam; Department of Epidemiology and Biostatistics (M.J.R.), Michigan State University, East Lansing; Department of Medicine (A.G.T., D.A.C.), School of Clinical Sciences at Monash Health, Monash University, Clayton; Florey Institute Neuroscience and Mental Health (D.A.C.), Heidelberg, University of Melbourne, Victoria; Faculty of Health and Medicine (J.S.), University of Newcastle; George Institute for Global Health (E.H., C.A.), University of Sydney, New South Wales, Australia; Hellenic Cardiovascular Research Society (K.V.), Athens, Greece; National Institute for Stroke and Applied Neurosciences (P.P., R.K., V.F.), School of Public Health and Psychosocial Studies, Auckland University of Technology; School of Psychology (S.B.-C.), University of Auckland, New Zealand; University of Burgundy (Y.B.), University Hospital of Dijon, France; Clinica Neurológica de Joinville (N.L.C.), Joinville Stroke Registry, University of Joinville Region, Brazil; Department of Biotechnological and Applied Clinical Sciences (A.C., S.S.), Neurological Institute, University of L'Aquila, Italy; Stroke Unit (N.C.), Centre Hospitalier Sud Francilien, Corbeil-Essonnes; Stroke Unit (S.O.), University Hospital of Bordeaux, France; Stroke Prevention Research Unit (P.R.), Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK; UNIFAI (C.S., M.C., R.M.), Instituto de Ciências Biomédicas de Abel Salazar, Universidade do Porto, Portugal; Department of Neurology (P.A.), Faculty of Medicine and Health, Örebro University, Sweden; Department of Neurology and Neurosurgery (J.K., R.V.), University of Tartu, Estonia; and Hospital Carlos Fernando Malzoni and Neurologic Center of Research and Rehabilitation (C.M.), Matão, SP, Brazil.
Konstantinos Vemmos
From the Menzies Institute for Medical Research Tasmania (H.T.P., C.L.B., P.O., S.L.G.), University of Tasmania, Hobart, Australia; Department of Health Management and Health Economics (H.T.P.), Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam; Department of Epidemiology and Biostatistics (M.J.R.), Michigan State University, East Lansing; Department of Medicine (A.G.T., D.A.C.), School of Clinical Sciences at Monash Health, Monash University, Clayton; Florey Institute Neuroscience and Mental Health (D.A.C.), Heidelberg, University of Melbourne, Victoria; Faculty of Health and Medicine (J.S.), University of Newcastle; George Institute for Global Health (E.H., C.A.), University of Sydney, New South Wales, Australia; Hellenic Cardiovascular Research Society (K.V.), Athens, Greece; National Institute for Stroke and Applied Neurosciences (P.P., R.K., V.F.), School of Public Health and Psychosocial Studies, Auckland University of Technology; School of Psychology (S.B.-C.), University of Auckland, New Zealand; University of Burgundy (Y.B.), University Hospital of Dijon, France; Clinica Neurológica de Joinville (N.L.C.), Joinville Stroke Registry, University of Joinville Region, Brazil; Department of Biotechnological and Applied Clinical Sciences (A.C., S.S.), Neurological Institute, University of L'Aquila, Italy; Stroke Unit (N.C.), Centre Hospitalier Sud Francilien, Corbeil-Essonnes; Stroke Unit (S.O.), University Hospital of Bordeaux, France; Stroke Prevention Research Unit (P.R.), Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK; UNIFAI (C.S., M.C., R.M.), Instituto de Ciências Biomédicas de Abel Salazar, Universidade do Porto, Portugal; Department of Neurology (P.A.), Faculty of Medicine and Health, Örebro University, Sweden; Department of Neurology and Neurosurgery (J.K., R.V.), University of Tartu, Estonia; and Hospital Carlos Fernando Malzoni and Neurologic Center of Research and Rehabilitation (C.M.), Matão, SP, Brazil.
Craig Anderson
From the Menzies Institute for Medical Research Tasmania (H.T.P., C.L.B., P.O., S.L.G.), University of Tasmania, Hobart, Australia; Department of Health Management and Health Economics (H.T.P.), Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam; Department of Epidemiology and Biostatistics (M.J.R.), Michigan State University, East Lansing; Department of Medicine (A.G.T., D.A.C.), School of Clinical Sciences at Monash Health, Monash University, Clayton; Florey Institute Neuroscience and Mental Health (D.A.C.), Heidelberg, University of Melbourne, Victoria; Faculty of Health and Medicine (J.S.), University of Newcastle; George Institute for Global Health (E.H., C.A.), University of Sydney, New South Wales, Australia; Hellenic Cardiovascular Research Society (K.V.), Athens, Greece; National Institute for Stroke and Applied Neurosciences (P.P., R.K., V.F.), School of Public Health and Psychosocial Studies, Auckland University of Technology; School of Psychology (S.B.-C.), University of Auckland, New Zealand; University of Burgundy (Y.B.), University Hospital of Dijon, France; Clinica Neurológica de Joinville (N.L.C.), Joinville Stroke Registry, University of Joinville Region, Brazil; Department of Biotechnological and Applied Clinical Sciences (A.C., S.S.), Neurological Institute, University of L'Aquila, Italy; Stroke Unit (N.C.), Centre Hospitalier Sud Francilien, Corbeil-Essonnes; Stroke Unit (S.O.), University Hospital of Bordeaux, France; Stroke Prevention Research Unit (P.R.), Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK; UNIFAI (C.S., M.C., R.M.), Instituto de Ciências Biomédicas de Abel Salazar, Universidade do Porto, Portugal; Department of Neurology (P.A.), Faculty of Medicine and Health, Örebro University, Sweden; Department of Neurology and Neurosurgery (J.K., R.V.), University of Tartu, Estonia; and Hospital Carlos Fernando Malzoni and Neurologic Center of Research and Rehabilitation (C.M.), Matão, SP, Brazil.
Priya Parmar
From the Menzies Institute for Medical Research Tasmania (H.T.P., C.L.B., P.O., S.L.G.), University of Tasmania, Hobart, Australia; Department of Health Management and Health Economics (H.T.P.), Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam; Department of Epidemiology and Biostatistics (M.J.R.), Michigan State University, East Lansing; Department of Medicine (A.G.T., D.A.C.), School of Clinical Sciences at Monash Health, Monash University, Clayton; Florey Institute Neuroscience and Mental Health (D.A.C.), Heidelberg, University of Melbourne, Victoria; Faculty of Health and Medicine (J.S.), University of Newcastle; George Institute for Global Health (E.H., C.A.), University of Sydney, New South Wales, Australia; Hellenic Cardiovascular Research Society (K.V.), Athens, Greece; National Institute for Stroke and Applied Neurosciences (P.P., R.K., V.F.), School of Public Health and Psychosocial Studies, Auckland University of Technology; School of Psychology (S.B.-C.), University of Auckland, New Zealand; University of Burgundy (Y.B.), University Hospital of Dijon, France; Clinica Neurológica de Joinville (N.L.C.), Joinville Stroke Registry, University of Joinville Region, Brazil; Department of Biotechnological and Applied Clinical Sciences (A.C., S.S.), Neurological Institute, University of L'Aquila, Italy; Stroke Unit (N.C.), Centre Hospitalier Sud Francilien, Corbeil-Essonnes; Stroke Unit (S.O.), University Hospital of Bordeaux, France; Stroke Prevention Research Unit (P.R.), Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK; UNIFAI (C.S., M.C., R.M.), Instituto de Ciências Biomédicas de Abel Salazar, Universidade do Porto, Portugal; Department of Neurology (P.A.), Faculty of Medicine and Health, Örebro University, Sweden; Department of Neurology and Neurosurgery (J.K., R.V.), University of Tartu, Estonia; and Hospital Carlos Fernando Malzoni and Neurologic Center of Research and Rehabilitation (C.M.), Matão, SP, Brazil.
Rita Krishnamurthi
From the Menzies Institute for Medical Research Tasmania (H.T.P., C.L.B., P.O., S.L.G.), University of Tasmania, Hobart, Australia; Department of Health Management and Health Economics (H.T.P.), Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam; Department of Epidemiology and Biostatistics (M.J.R.), Michigan State University, East Lansing; Department of Medicine (A.G.T., D.A.C.), School of Clinical Sciences at Monash Health, Monash University, Clayton; Florey Institute Neuroscience and Mental Health (D.A.C.), Heidelberg, University of Melbourne, Victoria; Faculty of Health and Medicine (J.S.), University of Newcastle; George Institute for Global Health (E.H., C.A.), University of Sydney, New South Wales, Australia; Hellenic Cardiovascular Research Society (K.V.), Athens, Greece; National Institute for Stroke and Applied Neurosciences (P.P., R.K., V.F.), School of Public Health and Psychosocial Studies, Auckland University of Technology; School of Psychology (S.B.-C.), University of Auckland, New Zealand; University of Burgundy (Y.B.), University Hospital of Dijon, France; Clinica Neurológica de Joinville (N.L.C.), Joinville Stroke Registry, University of Joinville Region, Brazil; Department of Biotechnological and Applied Clinical Sciences (A.C., S.S.), Neurological Institute, University of L'Aquila, Italy; Stroke Unit (N.C.), Centre Hospitalier Sud Francilien, Corbeil-Essonnes; Stroke Unit (S.O.), University Hospital of Bordeaux, France; Stroke Prevention Research Unit (P.R.), Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK; UNIFAI (C.S., M.C., R.M.), Instituto de Ciências Biomédicas de Abel Salazar, Universidade do Porto, Portugal; Department of Neurology (P.A.), Faculty of Medicine and Health, Örebro University, Sweden; Department of Neurology and Neurosurgery (J.K., R.V.), University of Tartu, Estonia; and Hospital Carlos Fernando Malzoni and Neurologic Center of Research and Rehabilitation (C.M.), Matão, SP, Brazil.
Suzanne Barker-Collo
From the Menzies Institute for Medical Research Tasmania (H.T.P., C.L.B., P.O., S.L.G.), University of Tasmania, Hobart, Australia; Department of Health Management and Health Economics (H.T.P.), Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam; Department of Epidemiology and Biostatistics (M.J.R.), Michigan State University, East Lansing; Department of Medicine (A.G.T., D.A.C.), School of Clinical Sciences at Monash Health, Monash University, Clayton; Florey Institute Neuroscience and Mental Health (D.A.C.), Heidelberg, University of Melbourne, Victoria; Faculty of Health and Medicine (J.S.), University of Newcastle; George Institute for Global Health (E.H., C.A.), University of Sydney, New South Wales, Australia; Hellenic Cardiovascular Research Society (K.V.), Athens, Greece; National Institute for Stroke and Applied Neurosciences (P.P., R.K., V.F.), School of Public Health and Psychosocial Studies, Auckland University of Technology; School of Psychology (S.B.-C.), University of Auckland, New Zealand; University of Burgundy (Y.B.), University Hospital of Dijon, France; Clinica Neurológica de Joinville (N.L.C.), Joinville Stroke Registry, University of Joinville Region, Brazil; Department of Biotechnological and Applied Clinical Sciences (A.C., S.S.), Neurological Institute, University of L'Aquila, Italy; Stroke Unit (N.C.), Centre Hospitalier Sud Francilien, Corbeil-Essonnes; Stroke Unit (S.O.), University Hospital of Bordeaux, France; Stroke Prevention Research Unit (P.R.), Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK; UNIFAI (C.S., M.C., R.M.), Instituto de Ciências Biomédicas de Abel Salazar, Universidade do Porto, Portugal; Department of Neurology (P.A.), Faculty of Medicine and Health, Örebro University, Sweden; Department of Neurology and Neurosurgery (J.K., R.V.), University of Tartu, Estonia; and Hospital Carlos Fernando Malzoni and Neurologic Center of Research and Rehabilitation (C.M.), Matão, SP, Brazil.
Valery Feigin
From the Menzies Institute for Medical Research Tasmania (H.T.P., C.L.B., P.O., S.L.G.), University of Tasmania, Hobart, Australia; Department of Health Management and Health Economics (H.T.P.), Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam; Department of Epidemiology and Biostatistics (M.J.R.), Michigan State University, East Lansing; Department of Medicine (A.G.T., D.A.C.), School of Clinical Sciences at Monash Health, Monash University, Clayton; Florey Institute Neuroscience and Mental Health (D.A.C.), Heidelberg, University of Melbourne, Victoria; Faculty of Health and Medicine (J.S.), University of Newcastle; George Institute for Global Health (E.H., C.A.), University of Sydney, New South Wales, Australia; Hellenic Cardiovascular Research Society (K.V.), Athens, Greece; National Institute for Stroke and Applied Neurosciences (P.P., R.K., V.F.), School of Public Health and Psychosocial Studies, Auckland University of Technology; School of Psychology (S.B.-C.), University of Auckland, New Zealand; University of Burgundy (Y.B.), University Hospital of Dijon, France; Clinica Neurológica de Joinville (N.L.C.), Joinville Stroke Registry, University of Joinville Region, Brazil; Department of Biotechnological and Applied Clinical Sciences (A.C., S.S.), Neurological Institute, University of L'Aquila, Italy; Stroke Unit (N.C.), Centre Hospitalier Sud Francilien, Corbeil-Essonnes; Stroke Unit (S.O.), University Hospital of Bordeaux, France; Stroke Prevention Research Unit (P.R.), Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK; UNIFAI (C.S., M.C., R.M.), Instituto de Ciências Biomédicas de Abel Salazar, Universidade do Porto, Portugal; Department of Neurology (P.A.), Faculty of Medicine and Health, Örebro University, Sweden; Department of Neurology and Neurosurgery (J.K., R.V.), University of Tartu, Estonia; and Hospital Carlos Fernando Malzoni and Neurologic Center of Research and Rehabilitation (C.M.), Matão, SP, Brazil.
Yannick Bejot
From the Menzies Institute for Medical Research Tasmania (H.T.P., C.L.B., P.O., S.L.G.), University of Tasmania, Hobart, Australia; Department of Health Management and Health Economics (H.T.P.), Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam; Department of Epidemiology and Biostatistics (M.J.R.), Michigan State University, East Lansing; Department of Medicine (A.G.T., D.A.C.), School of Clinical Sciences at Monash Health, Monash University, Clayton; Florey Institute Neuroscience and Mental Health (D.A.C.), Heidelberg, University of Melbourne, Victoria; Faculty of Health and Medicine (J.S.), University of Newcastle; George Institute for Global Health (E.H., C.A.), University of Sydney, New South Wales, Australia; Hellenic Cardiovascular Research Society (K.V.), Athens, Greece; National Institute for Stroke and Applied Neurosciences (P.P., R.K., V.F.), School of Public Health and Psychosocial Studies, Auckland University of Technology; School of Psychology (S.B.-C.), University of Auckland, New Zealand; University of Burgundy (Y.B.), University Hospital of Dijon, France; Clinica Neurológica de Joinville (N.L.C.), Joinville Stroke Registry, University of Joinville Region, Brazil; Department of Biotechnological and Applied Clinical Sciences (A.C., S.S.), Neurological Institute, University of L'Aquila, Italy; Stroke Unit (N.C.), Centre Hospitalier Sud Francilien, Corbeil-Essonnes; Stroke Unit (S.O.), University Hospital of Bordeaux, France; Stroke Prevention Research Unit (P.R.), Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK; UNIFAI (C.S., M.C., R.M.), Instituto de Ciências Biomédicas de Abel Salazar, Universidade do Porto, Portugal; Department of Neurology (P.A.), Faculty of Medicine and Health, Örebro University, Sweden; Department of Neurology and Neurosurgery (J.K., R.V.), University of Tartu, Estonia; and Hospital Carlos Fernando Malzoni and Neurologic Center of Research and Rehabilitation (C.M.), Matão, SP, Brazil.
Norberto Luiz Cabral
From the Menzies Institute for Medical Research Tasmania (H.T.P., C.L.B., P.O., S.L.G.), University of Tasmania, Hobart, Australia; Department of Health Management and Health Economics (H.T.P.), Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam; Department of Epidemiology and Biostatistics (M.J.R.), Michigan State University, East Lansing; Department of Medicine (A.G.T., D.A.C.), School of Clinical Sciences at Monash Health, Monash University, Clayton; Florey Institute Neuroscience and Mental Health (D.A.C.), Heidelberg, University of Melbourne, Victoria; Faculty of Health and Medicine (J.S.), University of Newcastle; George Institute for Global Health (E.H., C.A.), University of Sydney, New South Wales, Australia; Hellenic Cardiovascular Research Society (K.V.), Athens, Greece; National Institute for Stroke and Applied Neurosciences (P.P., R.K., V.F.), School of Public Health and Psychosocial Studies, Auckland University of Technology; School of Psychology (S.B.-C.), University of Auckland, New Zealand; University of Burgundy (Y.B.), University Hospital of Dijon, France; Clinica Neurológica de Joinville (N.L.C.), Joinville Stroke Registry, University of Joinville Region, Brazil; Department of Biotechnological and Applied Clinical Sciences (A.C., S.S.), Neurological Institute, University of L'Aquila, Italy; Stroke Unit (N.C.), Centre Hospitalier Sud Francilien, Corbeil-Essonnes; Stroke Unit (S.O.), University Hospital of Bordeaux, France; Stroke Prevention Research Unit (P.R.), Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK; UNIFAI (C.S., M.C., R.M.), Instituto de Ciências Biomédicas de Abel Salazar, Universidade do Porto, Portugal; Department of Neurology (P.A.), Faculty of Medicine and Health, Örebro University, Sweden; Department of Neurology and Neurosurgery (J.K., R.V.), University of Tartu, Estonia; and Hospital Carlos Fernando Malzoni and Neurologic Center of Research and Rehabilitation (C.M.), Matão, SP, Brazil.
Antonio Carolei
From the Menzies Institute for Medical Research Tasmania (H.T.P., C.L.B., P.O., S.L.G.), University of Tasmania, Hobart, Australia; Department of Health Management and Health Economics (H.T.P.), Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam; Department of Epidemiology and Biostatistics (M.J.R.), Michigan State University, East Lansing; Department of Medicine (A.G.T., D.A.C.), School of Clinical Sciences at Monash Health, Monash University, Clayton; Florey Institute Neuroscience and Mental Health (D.A.C.), Heidelberg, University of Melbourne, Victoria; Faculty of Health and Medicine (J.S.), University of Newcastle; George Institute for Global Health (E.H., C.A.), University of Sydney, New South Wales, Australia; Hellenic Cardiovascular Research Society (K.V.), Athens, Greece; National Institute for Stroke and Applied Neurosciences (P.P., R.K., V.F.), School of Public Health and Psychosocial Studies, Auckland University of Technology; School of Psychology (S.B.-C.), University of Auckland, New Zealand; University of Burgundy (Y.B.), University Hospital of Dijon, France; Clinica Neurológica de Joinville (N.L.C.), Joinville Stroke Registry, University of Joinville Region, Brazil; Department of Biotechnological and Applied Clinical Sciences (A.C., S.S.), Neurological Institute, University of L'Aquila, Italy; Stroke Unit (N.C.), Centre Hospitalier Sud Francilien, Corbeil-Essonnes; Stroke Unit (S.O.), University Hospital of Bordeaux, France; Stroke Prevention Research Unit (P.R.), Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK; UNIFAI (C.S., M.C., R.M.), Instituto de Ciências Biomédicas de Abel Salazar, Universidade do Porto, Portugal; Department of Neurology (P.A.), Faculty of Medicine and Health, Örebro University, Sweden; Department of Neurology and Neurosurgery (J.K., R.V.), University of Tartu, Estonia; and Hospital Carlos Fernando Malzoni and Neurologic Center of Research and Rehabilitation (C.M.), Matão, SP, Brazil.
Simona Sacco
From the Menzies Institute for Medical Research Tasmania (H.T.P., C.L.B., P.O., S.L.G.), University of Tasmania, Hobart, Australia; Department of Health Management and Health Economics (H.T.P.), Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam; Department of Epidemiology and Biostatistics (M.J.R.), Michigan State University, East Lansing; Department of Medicine (A.G.T., D.A.C.), School of Clinical Sciences at Monash Health, Monash University, Clayton; Florey Institute Neuroscience and Mental Health (D.A.C.), Heidelberg, University of Melbourne, Victoria; Faculty of Health and Medicine (J.S.), University of Newcastle; George Institute for Global Health (E.H., C.A.), University of Sydney, New South Wales, Australia; Hellenic Cardiovascular Research Society (K.V.), Athens, Greece; National Institute for Stroke and Applied Neurosciences (P.P., R.K., V.F.), School of Public Health and Psychosocial Studies, Auckland University of Technology; School of Psychology (S.B.-C.), University of Auckland, New Zealand; University of Burgundy (Y.B.), University Hospital of Dijon, France; Clinica Neurológica de Joinville (N.L.C.), Joinville Stroke Registry, University of Joinville Region, Brazil; Department of Biotechnological and Applied Clinical Sciences (A.C., S.S.), Neurological Institute, University of L'Aquila, Italy; Stroke Unit (N.C.), Centre Hospitalier Sud Francilien, Corbeil-Essonnes; Stroke Unit (S.O.), University Hospital of Bordeaux, France; Stroke Prevention Research Unit (P.R.), Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK; UNIFAI (C.S., M.C., R.M.), Instituto de Ciências Biomédicas de Abel Salazar, Universidade do Porto, Portugal; Department of Neurology (P.A.), Faculty of Medicine and Health, Örebro University, Sweden; Department of Neurology and Neurosurgery (J.K., R.V.), University of Tartu, Estonia; and Hospital Carlos Fernando Malzoni and Neurologic Center of Research and Rehabilitation (C.M.), Matão, SP, Brazil.
Nicolas Chausson
From the Menzies Institute for Medical Research Tasmania (H.T.P., C.L.B., P.O., S.L.G.), University of Tasmania, Hobart, Australia; Department of Health Management and Health Economics (H.T.P.), Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam; Department of Epidemiology and Biostatistics (M.J.R.), Michigan State University, East Lansing; Department of Medicine (A.G.T., D.A.C.), School of Clinical Sciences at Monash Health, Monash University, Clayton; Florey Institute Neuroscience and Mental Health (D.A.C.), Heidelberg, University of Melbourne, Victoria; Faculty of Health and Medicine (J.S.), University of Newcastle; George Institute for Global Health (E.H., C.A.), University of Sydney, New South Wales, Australia; Hellenic Cardiovascular Research Society (K.V.), Athens, Greece; National Institute for Stroke and Applied Neurosciences (P.P., R.K., V.F.), School of Public Health and Psychosocial Studies, Auckland University of Technology; School of Psychology (S.B.-C.), University of Auckland, New Zealand; University of Burgundy (Y.B.), University Hospital of Dijon, France; Clinica Neurológica de Joinville (N.L.C.), Joinville Stroke Registry, University of Joinville Region, Brazil; Department of Biotechnological and Applied Clinical Sciences (A.C., S.S.), Neurological Institute, University of L'Aquila, Italy; Stroke Unit (N.C.), Centre Hospitalier Sud Francilien, Corbeil-Essonnes; Stroke Unit (S.O.), University Hospital of Bordeaux, France; Stroke Prevention Research Unit (P.R.), Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK; UNIFAI (C.S., M.C., R.M.), Instituto de Ciências Biomédicas de Abel Salazar, Universidade do Porto, Portugal; Department of Neurology (P.A.), Faculty of Medicine and Health, Örebro University, Sweden; Department of Neurology and Neurosurgery (J.K., R.V.), University of Tartu, Estonia; and Hospital Carlos Fernando Malzoni and Neurologic Center of Research and Rehabilitation (C.M.), Matão, SP, Brazil.
Stephane Olindo
From the Menzies Institute for Medical Research Tasmania (H.T.P., C.L.B., P.O., S.L.G.), University of Tasmania, Hobart, Australia; Department of Health Management and Health Economics (H.T.P.), Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam; Department of Epidemiology and Biostatistics (M.J.R.), Michigan State University, East Lansing; Department of Medicine (A.G.T., D.A.C.), School of Clinical Sciences at Monash Health, Monash University, Clayton; Florey Institute Neuroscience and Mental Health (D.A.C.), Heidelberg, University of Melbourne, Victoria; Faculty of Health and Medicine (J.S.), University of Newcastle; George Institute for Global Health (E.H., C.A.), University of Sydney, New South Wales, Australia; Hellenic Cardiovascular Research Society (K.V.), Athens, Greece; National Institute for Stroke and Applied Neurosciences (P.P., R.K., V.F.), School of Public Health and Psychosocial Studies, Auckland University of Technology; School of Psychology (S.B.-C.), University of Auckland, New Zealand; University of Burgundy (Y.B.), University Hospital of Dijon, France; Clinica Neurológica de Joinville (N.L.C.), Joinville Stroke Registry, University of Joinville Region, Brazil; Department of Biotechnological and Applied Clinical Sciences (A.C., S.S.), Neurological Institute, University of L'Aquila, Italy; Stroke Unit (N.C.), Centre Hospitalier Sud Francilien, Corbeil-Essonnes; Stroke Unit (S.O.), University Hospital of Bordeaux, France; Stroke Prevention Research Unit (P.R.), Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK; UNIFAI (C.S., M.C., R.M.), Instituto de Ciências Biomédicas de Abel Salazar, Universidade do Porto, Portugal; Department of Neurology (P.A.), Faculty of Medicine and Health, Örebro University, Sweden; Department of Neurology and Neurosurgery (J.K., R.V.), University of Tartu, Estonia; and Hospital Carlos Fernando Malzoni and Neurologic Center of Research and Rehabilitation (C.M.), Matão, SP, Brazil.
Peter Rothwell
From the Menzies Institute for Medical Research Tasmania (H.T.P., C.L.B., P.O., S.L.G.), University of Tasmania, Hobart, Australia; Department of Health Management and Health Economics (H.T.P.), Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam; Department of Epidemiology and Biostatistics (M.J.R.), Michigan State University, East Lansing; Department of Medicine (A.G.T., D.A.C.), School of Clinical Sciences at Monash Health, Monash University, Clayton; Florey Institute Neuroscience and Mental Health (D.A.C.), Heidelberg, University of Melbourne, Victoria; Faculty of Health and Medicine (J.S.), University of Newcastle; George Institute for Global Health (E.H., C.A.), University of Sydney, New South Wales, Australia; Hellenic Cardiovascular Research Society (K.V.), Athens, Greece; National Institute for Stroke and Applied Neurosciences (P.P., R.K., V.F.), School of Public Health and Psychosocial Studies, Auckland University of Technology; School of Psychology (S.B.-C.), University of Auckland, New Zealand; University of Burgundy (Y.B.), University Hospital of Dijon, France; Clinica Neurológica de Joinville (N.L.C.), Joinville Stroke Registry, University of Joinville Region, Brazil; Department of Biotechnological and Applied Clinical Sciences (A.C., S.S.), Neurological Institute, University of L'Aquila, Italy; Stroke Unit (N.C.), Centre Hospitalier Sud Francilien, Corbeil-Essonnes; Stroke Unit (S.O.), University Hospital of Bordeaux, France; Stroke Prevention Research Unit (P.R.), Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK; UNIFAI (C.S., M.C., R.M.), Instituto de Ciências Biomédicas de Abel Salazar, Universidade do Porto, Portugal; Department of Neurology (P.A.), Faculty of Medicine and Health, Örebro University, Sweden; Department of Neurology and Neurosurgery (J.K., R.V.), University of Tartu, Estonia; and Hospital Carlos Fernando Malzoni and Neurologic Center of Research and Rehabilitation (C.M.), Matão, SP, Brazil.
Carolina Silva
From the Menzies Institute for Medical Research Tasmania (H.T.P., C.L.B., P.O., S.L.G.), University of Tasmania, Hobart, Australia; Department of Health Management and Health Economics (H.T.P.), Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam; Department of Epidemiology and Biostatistics (M.J.R.), Michigan State University, East Lansing; Department of Medicine (A.G.T., D.A.C.), School of Clinical Sciences at Monash Health, Monash University, Clayton; Florey Institute Neuroscience and Mental Health (D.A.C.), Heidelberg, University of Melbourne, Victoria; Faculty of Health and Medicine (J.S.), University of Newcastle; George Institute for Global Health (E.H., C.A.), University of Sydney, New South Wales, Australia; Hellenic Cardiovascular Research Society (K.V.), Athens, Greece; National Institute for Stroke and Applied Neurosciences (P.P., R.K., V.F.), School of Public Health and Psychosocial Studies, Auckland University of Technology; School of Psychology (S.B.-C.), University of Auckland, New Zealand; University of Burgundy (Y.B.), University Hospital of Dijon, France; Clinica Neurológica de Joinville (N.L.C.), Joinville Stroke Registry, University of Joinville Region, Brazil; Department of Biotechnological and Applied Clinical Sciences (A.C., S.S.), Neurological Institute, University of L'Aquila, Italy; Stroke Unit (N.C.), Centre Hospitalier Sud Francilien, Corbeil-Essonnes; Stroke Unit (S.O.), University Hospital of Bordeaux, France; Stroke Prevention Research Unit (P.R.), Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK; UNIFAI (C.S., M.C., R.M.), Instituto de Ciências Biomédicas de Abel Salazar, Universidade do Porto, Portugal; Department of Neurology (P.A.), Faculty of Medicine and Health, Örebro University, Sweden; Department of Neurology and Neurosurgery (J.K., R.V.), University of Tartu, Estonia; and Hospital Carlos Fernando Malzoni and Neurologic Center of Research and Rehabilitation (C.M.), Matão, SP, Brazil.
Manuel Correia
From the Menzies Institute for Medical Research Tasmania (H.T.P., C.L.B., P.O., S.L.G.), University of Tasmania, Hobart, Australia; Department of Health Management and Health Economics (H.T.P.), Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam; Department of Epidemiology and Biostatistics (M.J.R.), Michigan State University, East Lansing; Department of Medicine (A.G.T., D.A.C.), School of Clinical Sciences at Monash Health, Monash University, Clayton; Florey Institute Neuroscience and Mental Health (D.A.C.), Heidelberg, University of Melbourne, Victoria; Faculty of Health and Medicine (J.S.), University of Newcastle; George Institute for Global Health (E.H., C.A.), University of Sydney, New South Wales, Australia; Hellenic Cardiovascular Research Society (K.V.), Athens, Greece; National Institute for Stroke and Applied Neurosciences (P.P., R.K., V.F.), School of Public Health and Psychosocial Studies, Auckland University of Technology; School of Psychology (S.B.-C.), University of Auckland, New Zealand; University of Burgundy (Y.B.), University Hospital of Dijon, France; Clinica Neurológica de Joinville (N.L.C.), Joinville Stroke Registry, University of Joinville Region, Brazil; Department of Biotechnological and Applied Clinical Sciences (A.C., S.S.), Neurological Institute, University of L'Aquila, Italy; Stroke Unit (N.C.), Centre Hospitalier Sud Francilien, Corbeil-Essonnes; Stroke Unit (S.O.), University Hospital of Bordeaux, France; Stroke Prevention Research Unit (P.R.), Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK; UNIFAI (C.S., M.C., R.M.), Instituto de Ciências Biomédicas de Abel Salazar, Universidade do Porto, Portugal; Department of Neurology (P.A.), Faculty of Medicine and Health, Örebro University, Sweden; Department of Neurology and Neurosurgery (J.K., R.V.), University of Tartu, Estonia; and Hospital Carlos Fernando Malzoni and Neurologic Center of Research and Rehabilitation (C.M.), Matão, SP, Brazil.
Rui Magalhães
From the Menzies Institute for Medical Research Tasmania (H.T.P., C.L.B., P.O., S.L.G.), University of Tasmania, Hobart, Australia; Department of Health Management and Health Economics (H.T.P.), Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam; Department of Epidemiology and Biostatistics (M.J.R.), Michigan State University, East Lansing; Department of Medicine (A.G.T., D.A.C.), School of Clinical Sciences at Monash Health, Monash University, Clayton; Florey Institute Neuroscience and Mental Health (D.A.C.), Heidelberg, University of Melbourne, Victoria; Faculty of Health and Medicine (J.S.), University of Newcastle; George Institute for Global Health (E.H., C.A.), University of Sydney, New South Wales, Australia; Hellenic Cardiovascular Research Society (K.V.), Athens, Greece; National Institute for Stroke and Applied Neurosciences (P.P., R.K., V.F.), School of Public Health and Psychosocial Studies, Auckland University of Technology; School of Psychology (S.B.-C.), University of Auckland, New Zealand; University of Burgundy (Y.B.), University Hospital of Dijon, France; Clinica Neurológica de Joinville (N.L.C.), Joinville Stroke Registry, University of Joinville Region, Brazil; Department of Biotechnological and Applied Clinical Sciences (A.C., S.S.), Neurological Institute, University of L'Aquila, Italy; Stroke Unit (N.C.), Centre Hospitalier Sud Francilien, Corbeil-Essonnes; Stroke Unit (S.O.), University Hospital of Bordeaux, France; Stroke Prevention Research Unit (P.R.), Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK; UNIFAI (C.S., M.C., R.M.), Instituto de Ciências Biomédicas de Abel Salazar, Universidade do Porto, Portugal; Department of Neurology (P.A.), Faculty of Medicine and Health, Örebro University, Sweden; Department of Neurology and Neurosurgery (J.K., R.V.), University of Tartu, Estonia; and Hospital Carlos Fernando Malzoni and Neurologic Center of Research and Rehabilitation (C.M.), Matão, SP, Brazil.
Peter Appelros
From the Menzies Institute for Medical Research Tasmania (H.T.P., C.L.B., P.O., S.L.G.), University of Tasmania, Hobart, Australia; Department of Health Management and Health Economics (H.T.P.), Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam; Department of Epidemiology and Biostatistics (M.J.R.), Michigan State University, East Lansing; Department of Medicine (A.G.T., D.A.C.), School of Clinical Sciences at Monash Health, Monash University, Clayton; Florey Institute Neuroscience and Mental Health (D.A.C.), Heidelberg, University of Melbourne, Victoria; Faculty of Health and Medicine (J.S.), University of Newcastle; George Institute for Global Health (E.H., C.A.), University of Sydney, New South Wales, Australia; Hellenic Cardiovascular Research Society (K.V.), Athens, Greece; National Institute for Stroke and Applied Neurosciences (P.P., R.K., V.F.), School of Public Health and Psychosocial Studies, Auckland University of Technology; School of Psychology (S.B.-C.), University of Auckland, New Zealand; University of Burgundy (Y.B.), University Hospital of Dijon, France; Clinica Neurológica de Joinville (N.L.C.), Joinville Stroke Registry, University of Joinville Region, Brazil; Department of Biotechnological and Applied Clinical Sciences (A.C., S.S.), Neurological Institute, University of L'Aquila, Italy; Stroke Unit (N.C.), Centre Hospitalier Sud Francilien, Corbeil-Essonnes; Stroke Unit (S.O.), University Hospital of Bordeaux, France; Stroke Prevention Research Unit (P.R.), Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK; UNIFAI (C.S., M.C., R.M.), Instituto de Ciências Biomédicas de Abel Salazar, Universidade do Porto, Portugal; Department of Neurology (P.A.), Faculty of Medicine and Health, Örebro University, Sweden; Department of Neurology and Neurosurgery (J.K., R.V.), University of Tartu, Estonia; and Hospital Carlos Fernando Malzoni and Neurologic Center of Research and Rehabilitation (C.M.), Matão, SP, Brazil.
Janika Kõrv
From the Menzies Institute for Medical Research Tasmania (H.T.P., C.L.B., P.O., S.L.G.), University of Tasmania, Hobart, Australia; Department of Health Management and Health Economics (H.T.P.), Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam; Department of Epidemiology and Biostatistics (M.J.R.), Michigan State University, East Lansing; Department of Medicine (A.G.T., D.A.C.), School of Clinical Sciences at Monash Health, Monash University, Clayton; Florey Institute Neuroscience and Mental Health (D.A.C.), Heidelberg, University of Melbourne, Victoria; Faculty of Health and Medicine (J.S.), University of Newcastle; George Institute for Global Health (E.H., C.A.), University of Sydney, New South Wales, Australia; Hellenic Cardiovascular Research Society (K.V.), Athens, Greece; National Institute for Stroke and Applied Neurosciences (P.P., R.K., V.F.), School of Public Health and Psychosocial Studies, Auckland University of Technology; School of Psychology (S.B.-C.), University of Auckland, New Zealand; University of Burgundy (Y.B.), University Hospital of Dijon, France; Clinica Neurológica de Joinville (N.L.C.), Joinville Stroke Registry, University of Joinville Region, Brazil; Department of Biotechnological and Applied Clinical Sciences (A.C., S.S.), Neurological Institute, University of L'Aquila, Italy; Stroke Unit (N.C.), Centre Hospitalier Sud Francilien, Corbeil-Essonnes; Stroke Unit (S.O.), University Hospital of Bordeaux, France; Stroke Prevention Research Unit (P.R.), Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK; UNIFAI (C.S., M.C., R.M.), Instituto de Ciências Biomédicas de Abel Salazar, Universidade do Porto, Portugal; Department of Neurology (P.A.), Faculty of Medicine and Health, Örebro University, Sweden; Department of Neurology and Neurosurgery (J.K., R.V.), University of Tartu, Estonia; and Hospital Carlos Fernando Malzoni and Neurologic Center of Research and Rehabilitation (C.M.), Matão, SP, Brazil.
Riina Vibo
From the Menzies Institute for Medical Research Tasmania (H.T.P., C.L.B., P.O., S.L.G.), University of Tasmania, Hobart, Australia; Department of Health Management and Health Economics (H.T.P.), Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam; Department of Epidemiology and Biostatistics (M.J.R.), Michigan State University, East Lansing; Department of Medicine (A.G.T., D.A.C.), School of Clinical Sciences at Monash Health, Monash University, Clayton; Florey Institute Neuroscience and Mental Health (D.A.C.), Heidelberg, University of Melbourne, Victoria; Faculty of Health and Medicine (J.S.), University of Newcastle; George Institute for Global Health (E.H., C.A.), University of Sydney, New South Wales, Australia; Hellenic Cardiovascular Research Society (K.V.), Athens, Greece; National Institute for Stroke and Applied Neurosciences (P.P., R.K., V.F.), School of Public Health and Psychosocial Studies, Auckland University of Technology; School of Psychology (S.B.-C.), University of Auckland, New Zealand; University of Burgundy (Y.B.), University Hospital of Dijon, France; Clinica Neurológica de Joinville (N.L.C.), Joinville Stroke Registry, University of Joinville Region, Brazil; Department of Biotechnological and Applied Clinical Sciences (A.C., S.S.), Neurological Institute, University of L'Aquila, Italy; Stroke Unit (N.C.), Centre Hospitalier Sud Francilien, Corbeil-Essonnes; Stroke Unit (S.O.), University Hospital of Bordeaux, France; Stroke Prevention Research Unit (P.R.), Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK; UNIFAI (C.S., M.C., R.M.), Instituto de Ciências Biomédicas de Abel Salazar, Universidade do Porto, Portugal; Department of Neurology (P.A.), Faculty of Medicine and Health, Örebro University, Sweden; Department of Neurology and Neurosurgery (J.K., R.V.), University of Tartu, Estonia; and Hospital Carlos Fernando Malzoni and Neurologic Center of Research and Rehabilitation (C.M.), Matão, SP, Brazil.
Cesar Minelli
From the Menzies Institute for Medical Research Tasmania (H.T.P., C.L.B., P.O., S.L.G.), University of Tasmania, Hobart, Australia; Department of Health Management and Health Economics (H.T.P.), Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam; Department of Epidemiology and Biostatistics (M.J.R.), Michigan State University, East Lansing; Department of Medicine (A.G.T., D.A.C.), School of Clinical Sciences at Monash Health, Monash University, Clayton; Florey Institute Neuroscience and Mental Health (D.A.C.), Heidelberg, University of Melbourne, Victoria; Faculty of Health and Medicine (J.S.), University of Newcastle; George Institute for Global Health (E.H., C.A.), University of Sydney, New South Wales, Australia; Hellenic Cardiovascular Research Society (K.V.), Athens, Greece; National Institute for Stroke and Applied Neurosciences (P.P., R.K., V.F.), School of Public Health and Psychosocial Studies, Auckland University of Technology; School of Psychology (S.B.-C.), University of Auckland, New Zealand; University of Burgundy (Y.B.), University Hospital of Dijon, France; Clinica Neurológica de Joinville (N.L.C.), Joinville Stroke Registry, University of Joinville Region, Brazil; Department of Biotechnological and Applied Clinical Sciences (A.C., S.S.), Neurological Institute, University of L'Aquila, Italy; Stroke Unit (N.C.), Centre Hospitalier Sud Francilien, Corbeil-Essonnes; Stroke Unit (S.O.), University Hospital of Bordeaux, France; Stroke Prevention Research Unit (P.R.), Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK; UNIFAI (C.S., M.C., R.M.), Instituto de Ciências Biomédicas de Abel Salazar, Universidade do Porto, Portugal; Department of Neurology (P.A.), Faculty of Medicine and Health, Örebro University, Sweden; Department of Neurology and Neurosurgery (J.K., R.V.), University of Tartu, Estonia; and Hospital Carlos Fernando Malzoni and Neurologic Center of Research and Rehabilitation (C.M.), Matão, SP, Brazil.
Seana L. Gall
From the Menzies Institute for Medical Research Tasmania (H.T.P., C.L.B., P.O., S.L.G.), University of Tasmania, Hobart, Australia; Department of Health Management and Health Economics (H.T.P.), Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam; Department of Epidemiology and Biostatistics (M.J.R.), Michigan State University, East Lansing; Department of Medicine (A.G.T., D.A.C.), School of Clinical Sciences at Monash Health, Monash University, Clayton; Florey Institute Neuroscience and Mental Health (D.A.C.), Heidelberg, University of Melbourne, Victoria; Faculty of Health and Medicine (J.S.), University of Newcastle; George Institute for Global Health (E.H., C.A.), University of Sydney, New South Wales, Australia; Hellenic Cardiovascular Research Society (K.V.), Athens, Greece; National Institute for Stroke and Applied Neurosciences (P.P., R.K., V.F.), School of Public Health and Psychosocial Studies, Auckland University of Technology; School of Psychology (S.B.-C.), University of Auckland, New Zealand; University of Burgundy (Y.B.), University Hospital of Dijon, France; Clinica Neurológica de Joinville (N.L.C.), Joinville Stroke Registry, University of Joinville Region, Brazil; Department of Biotechnological and Applied Clinical Sciences (A.C., S.S.), Neurological Institute, University of L'Aquila, Italy; Stroke Unit (N.C.), Centre Hospitalier Sud Francilien, Corbeil-Essonnes; Stroke Unit (S.O.), University Hospital of Bordeaux, France; Stroke Prevention Research Unit (P.R.), Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK; UNIFAI (C.S., M.C., R.M.), Instituto de Ciências Biomédicas de Abel Salazar, Universidade do Porto, Portugal; Department of Neurology (P.A.), Faculty of Medicine and Health, Örebro University, Sweden; Department of Neurology and Neurosurgery (J.K., R.V.), University of Tartu, Estonia; and Hospital Carlos Fernando Malzoni and Neurologic Center of Research and Rehabilitation (C.M.), Matão, SP, Brazil.
Factors contributing to sex differences in functional outcomes and participation after stroke
Hoang T. Phan, Christopher L. Blizzard, Mathew J. Reeves, Amanda G. Thrift, Dominique A. Cadilhac, Jonathan Sturm, Emma Heeley, Petr Otahal, Konstantinos Vemmos, Craig Anderson, Priya Parmar, Rita Krishnamurthi, Suzanne Barker-Collo, Valery Feigin, Yannick Bejot, Norberto Luiz Cabral, Antonio Carolei, Simona Sacco, Nicolas Chausson, Stephane Olindo, Peter Rothwell, Carolina Silva, Manuel Correia, Rui Magalhães, Peter Appelros, Janika Kõrv, Riina Vibo, Cesar Minelli, Seana L. Gall
Neurology May 2018, 90 (22) e1945-e1953; DOI: 10.1212/WNL.0000000000005602
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Abstract
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 RRunadjusted 1.32, 95% confidence interval [CI] 1.18–1.48; 5 years: RRunadjusted 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: RRadjusted 1.08, 95% CI 0.97–1.20; 5 years: RRadjusted 1.05, 95% CI 0.94–1.18). Women also had greater participation restriction than men (pooled MDunadjusted −5.55, 95% CI −8.47 to −2.63), but this difference was again attenuated after adjustment for the aforementioned factors (MDadjusted −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.
Glossary
- BI=
- Barthel Index;
- CI=
- confidence interval;
- INSTRUCT=
- International Stroke Outcomes Study;
- IPD=
- individual participant data;
- LHS=
- London Handicap Scale;
- MD=
- mean difference;
- mRS=
- modified Rankin Scale;
- RR=
- relative risk
Footnotes
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
This study was approved by the Tasmanian Health and Medical Human Research Ethics Committee (H0014861). All of the participating studies had approval from their respective local Ethics Committees.
Editorial Page 995
- Received September 20, 2017.
- Accepted in final form February 23, 2018.
- © 2018 American Academy of Neurology
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