December 10, 2019; 93 (24) Article
Sex differences in treatment and outcome after stroke
Pooled analysis including 19,000 participants
View ORCID ProfileCheryl Carcel, Xia Wang, Else Charlotte Sandset, Candice Delcourt, Hisatomi Arima, View ORCID ProfileRichard Lindley, Maree L. Hackett, Pablo Lavados, Thompson G. Robinson, Paula Muñoz Venturelli, Verónica V. Olavarría, Alejandro Brunser, Eivind Berge, View ORCID ProfileJohn Chalmers, Mark Woodward, Craig S. Anderson
First published November 12, 2019, DOI: https://doi.org/10.1212/WNL.0000000000008615
Cheryl Carcel
From The George Institute for Global Health (C.C., X.W., C.D., M.L.H., P.M.V., J.C., M.W., C.S.A.), University of New South Wales, Sydney; Sydney School of Public Health, Sydney Medical School (C.C., X.W., C.D., M.L.H., C.S.A.), The University of Sydney, New South Wales, Australia; Departments of Neurology (E.C.S.) and Internal Medicine (E.B.), Oslo University Hospital; Department of Research and Development (E.C.S.), The Norwegian Air Ambulance Foundation, Oslo, Norway; Department of Neurology (C.D.), Royal Prince Alfred Hospital, Sydney, Australia; Department of Public Health (H.A.), Fukuoka University, Japan; The George Institute for Global Health and Westmead Clinical School (R.L.), University of Sydney, Australia; Faculty of Health and Wellbeing (M.L.H.), The University of Central Lancashire, Preston, UK; Unidad de Neurología Vascular (P.L., P.M.V., V.V.O., A.B.), Servicio de Neurología, Departamento de Neurología y Psiquiatría, Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago; Departamento de Ciencias Neurológicas (P.L.), Facultad de Medicina, Universidad de Chile; Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Centre (T.G.R.), University of Leicester, UK; Centro de Estudios Clínicos (P.M.V.), Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago; Departamento de Paciente Crítico (V.V.O.), Clínica Alemana de Santiago, Chile; The George Institute for Global Health (M.W.), University of Oxford, UK; Department of Epidemiology (M.W.), Johns Hopkins University, Baltimore, MD; and The George Institute China at Peking University Health Science Centre (C.S.A.), Beijing, China.
Xia Wang
From The George Institute for Global Health (C.C., X.W., C.D., M.L.H., P.M.V., J.C., M.W., C.S.A.), University of New South Wales, Sydney; Sydney School of Public Health, Sydney Medical School (C.C., X.W., C.D., M.L.H., C.S.A.), The University of Sydney, New South Wales, Australia; Departments of Neurology (E.C.S.) and Internal Medicine (E.B.), Oslo University Hospital; Department of Research and Development (E.C.S.), The Norwegian Air Ambulance Foundation, Oslo, Norway; Department of Neurology (C.D.), Royal Prince Alfred Hospital, Sydney, Australia; Department of Public Health (H.A.), Fukuoka University, Japan; The George Institute for Global Health and Westmead Clinical School (R.L.), University of Sydney, Australia; Faculty of Health and Wellbeing (M.L.H.), The University of Central Lancashire, Preston, UK; Unidad de Neurología Vascular (P.L., P.M.V., V.V.O., A.B.), Servicio de Neurología, Departamento de Neurología y Psiquiatría, Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago; Departamento de Ciencias Neurológicas (P.L.), Facultad de Medicina, Universidad de Chile; Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Centre (T.G.R.), University of Leicester, UK; Centro de Estudios Clínicos (P.M.V.), Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago; Departamento de Paciente Crítico (V.V.O.), Clínica Alemana de Santiago, Chile; The George Institute for Global Health (M.W.), University of Oxford, UK; Department of Epidemiology (M.W.), Johns Hopkins University, Baltimore, MD; and The George Institute China at Peking University Health Science Centre (C.S.A.), Beijing, China.
Else Charlotte Sandset
From The George Institute for Global Health (C.C., X.W., C.D., M.L.H., P.M.V., J.C., M.W., C.S.A.), University of New South Wales, Sydney; Sydney School of Public Health, Sydney Medical School (C.C., X.W., C.D., M.L.H., C.S.A.), The University of Sydney, New South Wales, Australia; Departments of Neurology (E.C.S.) and Internal Medicine (E.B.), Oslo University Hospital; Department of Research and Development (E.C.S.), The Norwegian Air Ambulance Foundation, Oslo, Norway; Department of Neurology (C.D.), Royal Prince Alfred Hospital, Sydney, Australia; Department of Public Health (H.A.), Fukuoka University, Japan; The George Institute for Global Health and Westmead Clinical School (R.L.), University of Sydney, Australia; Faculty of Health and Wellbeing (M.L.H.), The University of Central Lancashire, Preston, UK; Unidad de Neurología Vascular (P.L., P.M.V., V.V.O., A.B.), Servicio de Neurología, Departamento de Neurología y Psiquiatría, Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago; Departamento de Ciencias Neurológicas (P.L.), Facultad de Medicina, Universidad de Chile; Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Centre (T.G.R.), University of Leicester, UK; Centro de Estudios Clínicos (P.M.V.), Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago; Departamento de Paciente Crítico (V.V.O.), Clínica Alemana de Santiago, Chile; The George Institute for Global Health (M.W.), University of Oxford, UK; Department of Epidemiology (M.W.), Johns Hopkins University, Baltimore, MD; and The George Institute China at Peking University Health Science Centre (C.S.A.), Beijing, China.
Candice Delcourt
From The George Institute for Global Health (C.C., X.W., C.D., M.L.H., P.M.V., J.C., M.W., C.S.A.), University of New South Wales, Sydney; Sydney School of Public Health, Sydney Medical School (C.C., X.W., C.D., M.L.H., C.S.A.), The University of Sydney, New South Wales, Australia; Departments of Neurology (E.C.S.) and Internal Medicine (E.B.), Oslo University Hospital; Department of Research and Development (E.C.S.), The Norwegian Air Ambulance Foundation, Oslo, Norway; Department of Neurology (C.D.), Royal Prince Alfred Hospital, Sydney, Australia; Department of Public Health (H.A.), Fukuoka University, Japan; The George Institute for Global Health and Westmead Clinical School (R.L.), University of Sydney, Australia; Faculty of Health and Wellbeing (M.L.H.), The University of Central Lancashire, Preston, UK; Unidad de Neurología Vascular (P.L., P.M.V., V.V.O., A.B.), Servicio de Neurología, Departamento de Neurología y Psiquiatría, Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago; Departamento de Ciencias Neurológicas (P.L.), Facultad de Medicina, Universidad de Chile; Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Centre (T.G.R.), University of Leicester, UK; Centro de Estudios Clínicos (P.M.V.), Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago; Departamento de Paciente Crítico (V.V.O.), Clínica Alemana de Santiago, Chile; The George Institute for Global Health (M.W.), University of Oxford, UK; Department of Epidemiology (M.W.), Johns Hopkins University, Baltimore, MD; and The George Institute China at Peking University Health Science Centre (C.S.A.), Beijing, China.
Hisatomi Arima
From The George Institute for Global Health (C.C., X.W., C.D., M.L.H., P.M.V., J.C., M.W., C.S.A.), University of New South Wales, Sydney; Sydney School of Public Health, Sydney Medical School (C.C., X.W., C.D., M.L.H., C.S.A.), The University of Sydney, New South Wales, Australia; Departments of Neurology (E.C.S.) and Internal Medicine (E.B.), Oslo University Hospital; Department of Research and Development (E.C.S.), The Norwegian Air Ambulance Foundation, Oslo, Norway; Department of Neurology (C.D.), Royal Prince Alfred Hospital, Sydney, Australia; Department of Public Health (H.A.), Fukuoka University, Japan; The George Institute for Global Health and Westmead Clinical School (R.L.), University of Sydney, Australia; Faculty of Health and Wellbeing (M.L.H.), The University of Central Lancashire, Preston, UK; Unidad de Neurología Vascular (P.L., P.M.V., V.V.O., A.B.), Servicio de Neurología, Departamento de Neurología y Psiquiatría, Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago; Departamento de Ciencias Neurológicas (P.L.), Facultad de Medicina, Universidad de Chile; Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Centre (T.G.R.), University of Leicester, UK; Centro de Estudios Clínicos (P.M.V.), Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago; Departamento de Paciente Crítico (V.V.O.), Clínica Alemana de Santiago, Chile; The George Institute for Global Health (M.W.), University of Oxford, UK; Department of Epidemiology (M.W.), Johns Hopkins University, Baltimore, MD; and The George Institute China at Peking University Health Science Centre (C.S.A.), Beijing, China.
Richard Lindley
From The George Institute for Global Health (C.C., X.W., C.D., M.L.H., P.M.V., J.C., M.W., C.S.A.), University of New South Wales, Sydney; Sydney School of Public Health, Sydney Medical School (C.C., X.W., C.D., M.L.H., C.S.A.), The University of Sydney, New South Wales, Australia; Departments of Neurology (E.C.S.) and Internal Medicine (E.B.), Oslo University Hospital; Department of Research and Development (E.C.S.), The Norwegian Air Ambulance Foundation, Oslo, Norway; Department of Neurology (C.D.), Royal Prince Alfred Hospital, Sydney, Australia; Department of Public Health (H.A.), Fukuoka University, Japan; The George Institute for Global Health and Westmead Clinical School (R.L.), University of Sydney, Australia; Faculty of Health and Wellbeing (M.L.H.), The University of Central Lancashire, Preston, UK; Unidad de Neurología Vascular (P.L., P.M.V., V.V.O., A.B.), Servicio de Neurología, Departamento de Neurología y Psiquiatría, Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago; Departamento de Ciencias Neurológicas (P.L.), Facultad de Medicina, Universidad de Chile; Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Centre (T.G.R.), University of Leicester, UK; Centro de Estudios Clínicos (P.M.V.), Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago; Departamento de Paciente Crítico (V.V.O.), Clínica Alemana de Santiago, Chile; The George Institute for Global Health (M.W.), University of Oxford, UK; Department of Epidemiology (M.W.), Johns Hopkins University, Baltimore, MD; and The George Institute China at Peking University Health Science Centre (C.S.A.), Beijing, China.
Maree L. Hackett
From The George Institute for Global Health (C.C., X.W., C.D., M.L.H., P.M.V., J.C., M.W., C.S.A.), University of New South Wales, Sydney; Sydney School of Public Health, Sydney Medical School (C.C., X.W., C.D., M.L.H., C.S.A.), The University of Sydney, New South Wales, Australia; Departments of Neurology (E.C.S.) and Internal Medicine (E.B.), Oslo University Hospital; Department of Research and Development (E.C.S.), The Norwegian Air Ambulance Foundation, Oslo, Norway; Department of Neurology (C.D.), Royal Prince Alfred Hospital, Sydney, Australia; Department of Public Health (H.A.), Fukuoka University, Japan; The George Institute for Global Health and Westmead Clinical School (R.L.), University of Sydney, Australia; Faculty of Health and Wellbeing (M.L.H.), The University of Central Lancashire, Preston, UK; Unidad de Neurología Vascular (P.L., P.M.V., V.V.O., A.B.), Servicio de Neurología, Departamento de Neurología y Psiquiatría, Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago; Departamento de Ciencias Neurológicas (P.L.), Facultad de Medicina, Universidad de Chile; Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Centre (T.G.R.), University of Leicester, UK; Centro de Estudios Clínicos (P.M.V.), Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago; Departamento de Paciente Crítico (V.V.O.), Clínica Alemana de Santiago, Chile; The George Institute for Global Health (M.W.), University of Oxford, UK; Department of Epidemiology (M.W.), Johns Hopkins University, Baltimore, MD; and The George Institute China at Peking University Health Science Centre (C.S.A.), Beijing, China.
Pablo Lavados
From The George Institute for Global Health (C.C., X.W., C.D., M.L.H., P.M.V., J.C., M.W., C.S.A.), University of New South Wales, Sydney; Sydney School of Public Health, Sydney Medical School (C.C., X.W., C.D., M.L.H., C.S.A.), The University of Sydney, New South Wales, Australia; Departments of Neurology (E.C.S.) and Internal Medicine (E.B.), Oslo University Hospital; Department of Research and Development (E.C.S.), The Norwegian Air Ambulance Foundation, Oslo, Norway; Department of Neurology (C.D.), Royal Prince Alfred Hospital, Sydney, Australia; Department of Public Health (H.A.), Fukuoka University, Japan; The George Institute for Global Health and Westmead Clinical School (R.L.), University of Sydney, Australia; Faculty of Health and Wellbeing (M.L.H.), The University of Central Lancashire, Preston, UK; Unidad de Neurología Vascular (P.L., P.M.V., V.V.O., A.B.), Servicio de Neurología, Departamento de Neurología y Psiquiatría, Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago; Departamento de Ciencias Neurológicas (P.L.), Facultad de Medicina, Universidad de Chile; Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Centre (T.G.R.), University of Leicester, UK; Centro de Estudios Clínicos (P.M.V.), Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago; Departamento de Paciente Crítico (V.V.O.), Clínica Alemana de Santiago, Chile; The George Institute for Global Health (M.W.), University of Oxford, UK; Department of Epidemiology (M.W.), Johns Hopkins University, Baltimore, MD; and The George Institute China at Peking University Health Science Centre (C.S.A.), Beijing, China.
Thompson G. Robinson
From The George Institute for Global Health (C.C., X.W., C.D., M.L.H., P.M.V., J.C., M.W., C.S.A.), University of New South Wales, Sydney; Sydney School of Public Health, Sydney Medical School (C.C., X.W., C.D., M.L.H., C.S.A.), The University of Sydney, New South Wales, Australia; Departments of Neurology (E.C.S.) and Internal Medicine (E.B.), Oslo University Hospital; Department of Research and Development (E.C.S.), The Norwegian Air Ambulance Foundation, Oslo, Norway; Department of Neurology (C.D.), Royal Prince Alfred Hospital, Sydney, Australia; Department of Public Health (H.A.), Fukuoka University, Japan; The George Institute for Global Health and Westmead Clinical School (R.L.), University of Sydney, Australia; Faculty of Health and Wellbeing (M.L.H.), The University of Central Lancashire, Preston, UK; Unidad de Neurología Vascular (P.L., P.M.V., V.V.O., A.B.), Servicio de Neurología, Departamento de Neurología y Psiquiatría, Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago; Departamento de Ciencias Neurológicas (P.L.), Facultad de Medicina, Universidad de Chile; Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Centre (T.G.R.), University of Leicester, UK; Centro de Estudios Clínicos (P.M.V.), Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago; Departamento de Paciente Crítico (V.V.O.), Clínica Alemana de Santiago, Chile; The George Institute for Global Health (M.W.), University of Oxford, UK; Department of Epidemiology (M.W.), Johns Hopkins University, Baltimore, MD; and The George Institute China at Peking University Health Science Centre (C.S.A.), Beijing, China.
Paula Muñoz Venturelli
From The George Institute for Global Health (C.C., X.W., C.D., M.L.H., P.M.V., J.C., M.W., C.S.A.), University of New South Wales, Sydney; Sydney School of Public Health, Sydney Medical School (C.C., X.W., C.D., M.L.H., C.S.A.), The University of Sydney, New South Wales, Australia; Departments of Neurology (E.C.S.) and Internal Medicine (E.B.), Oslo University Hospital; Department of Research and Development (E.C.S.), The Norwegian Air Ambulance Foundation, Oslo, Norway; Department of Neurology (C.D.), Royal Prince Alfred Hospital, Sydney, Australia; Department of Public Health (H.A.), Fukuoka University, Japan; The George Institute for Global Health and Westmead Clinical School (R.L.), University of Sydney, Australia; Faculty of Health and Wellbeing (M.L.H.), The University of Central Lancashire, Preston, UK; Unidad de Neurología Vascular (P.L., P.M.V., V.V.O., A.B.), Servicio de Neurología, Departamento de Neurología y Psiquiatría, Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago; Departamento de Ciencias Neurológicas (P.L.), Facultad de Medicina, Universidad de Chile; Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Centre (T.G.R.), University of Leicester, UK; Centro de Estudios Clínicos (P.M.V.), Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago; Departamento de Paciente Crítico (V.V.O.), Clínica Alemana de Santiago, Chile; The George Institute for Global Health (M.W.), University of Oxford, UK; Department of Epidemiology (M.W.), Johns Hopkins University, Baltimore, MD; and The George Institute China at Peking University Health Science Centre (C.S.A.), Beijing, China.
Verónica V. Olavarría
From The George Institute for Global Health (C.C., X.W., C.D., M.L.H., P.M.V., J.C., M.W., C.S.A.), University of New South Wales, Sydney; Sydney School of Public Health, Sydney Medical School (C.C., X.W., C.D., M.L.H., C.S.A.), The University of Sydney, New South Wales, Australia; Departments of Neurology (E.C.S.) and Internal Medicine (E.B.), Oslo University Hospital; Department of Research and Development (E.C.S.), The Norwegian Air Ambulance Foundation, Oslo, Norway; Department of Neurology (C.D.), Royal Prince Alfred Hospital, Sydney, Australia; Department of Public Health (H.A.), Fukuoka University, Japan; The George Institute for Global Health and Westmead Clinical School (R.L.), University of Sydney, Australia; Faculty of Health and Wellbeing (M.L.H.), The University of Central Lancashire, Preston, UK; Unidad de Neurología Vascular (P.L., P.M.V., V.V.O., A.B.), Servicio de Neurología, Departamento de Neurología y Psiquiatría, Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago; Departamento de Ciencias Neurológicas (P.L.), Facultad de Medicina, Universidad de Chile; Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Centre (T.G.R.), University of Leicester, UK; Centro de Estudios Clínicos (P.M.V.), Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago; Departamento de Paciente Crítico (V.V.O.), Clínica Alemana de Santiago, Chile; The George Institute for Global Health (M.W.), University of Oxford, UK; Department of Epidemiology (M.W.), Johns Hopkins University, Baltimore, MD; and The George Institute China at Peking University Health Science Centre (C.S.A.), Beijing, China.
Alejandro Brunser
From The George Institute for Global Health (C.C., X.W., C.D., M.L.H., P.M.V., J.C., M.W., C.S.A.), University of New South Wales, Sydney; Sydney School of Public Health, Sydney Medical School (C.C., X.W., C.D., M.L.H., C.S.A.), The University of Sydney, New South Wales, Australia; Departments of Neurology (E.C.S.) and Internal Medicine (E.B.), Oslo University Hospital; Department of Research and Development (E.C.S.), The Norwegian Air Ambulance Foundation, Oslo, Norway; Department of Neurology (C.D.), Royal Prince Alfred Hospital, Sydney, Australia; Department of Public Health (H.A.), Fukuoka University, Japan; The George Institute for Global Health and Westmead Clinical School (R.L.), University of Sydney, Australia; Faculty of Health and Wellbeing (M.L.H.), The University of Central Lancashire, Preston, UK; Unidad de Neurología Vascular (P.L., P.M.V., V.V.O., A.B.), Servicio de Neurología, Departamento de Neurología y Psiquiatría, Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago; Departamento de Ciencias Neurológicas (P.L.), Facultad de Medicina, Universidad de Chile; Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Centre (T.G.R.), University of Leicester, UK; Centro de Estudios Clínicos (P.M.V.), Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago; Departamento de Paciente Crítico (V.V.O.), Clínica Alemana de Santiago, Chile; The George Institute for Global Health (M.W.), University of Oxford, UK; Department of Epidemiology (M.W.), Johns Hopkins University, Baltimore, MD; and The George Institute China at Peking University Health Science Centre (C.S.A.), Beijing, China.
Eivind Berge
From The George Institute for Global Health (C.C., X.W., C.D., M.L.H., P.M.V., J.C., M.W., C.S.A.), University of New South Wales, Sydney; Sydney School of Public Health, Sydney Medical School (C.C., X.W., C.D., M.L.H., C.S.A.), The University of Sydney, New South Wales, Australia; Departments of Neurology (E.C.S.) and Internal Medicine (E.B.), Oslo University Hospital; Department of Research and Development (E.C.S.), The Norwegian Air Ambulance Foundation, Oslo, Norway; Department of Neurology (C.D.), Royal Prince Alfred Hospital, Sydney, Australia; Department of Public Health (H.A.), Fukuoka University, Japan; The George Institute for Global Health and Westmead Clinical School (R.L.), University of Sydney, Australia; Faculty of Health and Wellbeing (M.L.H.), The University of Central Lancashire, Preston, UK; Unidad de Neurología Vascular (P.L., P.M.V., V.V.O., A.B.), Servicio de Neurología, Departamento de Neurología y Psiquiatría, Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago; Departamento de Ciencias Neurológicas (P.L.), Facultad de Medicina, Universidad de Chile; Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Centre (T.G.R.), University of Leicester, UK; Centro de Estudios Clínicos (P.M.V.), Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago; Departamento de Paciente Crítico (V.V.O.), Clínica Alemana de Santiago, Chile; The George Institute for Global Health (M.W.), University of Oxford, UK; Department of Epidemiology (M.W.), Johns Hopkins University, Baltimore, MD; and The George Institute China at Peking University Health Science Centre (C.S.A.), Beijing, China.
John Chalmers
From The George Institute for Global Health (C.C., X.W., C.D., M.L.H., P.M.V., J.C., M.W., C.S.A.), University of New South Wales, Sydney; Sydney School of Public Health, Sydney Medical School (C.C., X.W., C.D., M.L.H., C.S.A.), The University of Sydney, New South Wales, Australia; Departments of Neurology (E.C.S.) and Internal Medicine (E.B.), Oslo University Hospital; Department of Research and Development (E.C.S.), The Norwegian Air Ambulance Foundation, Oslo, Norway; Department of Neurology (C.D.), Royal Prince Alfred Hospital, Sydney, Australia; Department of Public Health (H.A.), Fukuoka University, Japan; The George Institute for Global Health and Westmead Clinical School (R.L.), University of Sydney, Australia; Faculty of Health and Wellbeing (M.L.H.), The University of Central Lancashire, Preston, UK; Unidad de Neurología Vascular (P.L., P.M.V., V.V.O., A.B.), Servicio de Neurología, Departamento de Neurología y Psiquiatría, Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago; Departamento de Ciencias Neurológicas (P.L.), Facultad de Medicina, Universidad de Chile; Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Centre (T.G.R.), University of Leicester, UK; Centro de Estudios Clínicos (P.M.V.), Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago; Departamento de Paciente Crítico (V.V.O.), Clínica Alemana de Santiago, Chile; The George Institute for Global Health (M.W.), University of Oxford, UK; Department of Epidemiology (M.W.), Johns Hopkins University, Baltimore, MD; and The George Institute China at Peking University Health Science Centre (C.S.A.), Beijing, China.
Mark Woodward
From The George Institute for Global Health (C.C., X.W., C.D., M.L.H., P.M.V., J.C., M.W., C.S.A.), University of New South Wales, Sydney; Sydney School of Public Health, Sydney Medical School (C.C., X.W., C.D., M.L.H., C.S.A.), The University of Sydney, New South Wales, Australia; Departments of Neurology (E.C.S.) and Internal Medicine (E.B.), Oslo University Hospital; Department of Research and Development (E.C.S.), The Norwegian Air Ambulance Foundation, Oslo, Norway; Department of Neurology (C.D.), Royal Prince Alfred Hospital, Sydney, Australia; Department of Public Health (H.A.), Fukuoka University, Japan; The George Institute for Global Health and Westmead Clinical School (R.L.), University of Sydney, Australia; Faculty of Health and Wellbeing (M.L.H.), The University of Central Lancashire, Preston, UK; Unidad de Neurología Vascular (P.L., P.M.V., V.V.O., A.B.), Servicio de Neurología, Departamento de Neurología y Psiquiatría, Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago; Departamento de Ciencias Neurológicas (P.L.), Facultad de Medicina, Universidad de Chile; Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Centre (T.G.R.), University of Leicester, UK; Centro de Estudios Clínicos (P.M.V.), Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago; Departamento de Paciente Crítico (V.V.O.), Clínica Alemana de Santiago, Chile; The George Institute for Global Health (M.W.), University of Oxford, UK; Department of Epidemiology (M.W.), Johns Hopkins University, Baltimore, MD; and The George Institute China at Peking University Health Science Centre (C.S.A.), Beijing, China.
Craig S. Anderson
From The George Institute for Global Health (C.C., X.W., C.D., M.L.H., P.M.V., J.C., M.W., C.S.A.), University of New South Wales, Sydney; Sydney School of Public Health, Sydney Medical School (C.C., X.W., C.D., M.L.H., C.S.A.), The University of Sydney, New South Wales, Australia; Departments of Neurology (E.C.S.) and Internal Medicine (E.B.), Oslo University Hospital; Department of Research and Development (E.C.S.), The Norwegian Air Ambulance Foundation, Oslo, Norway; Department of Neurology (C.D.), Royal Prince Alfred Hospital, Sydney, Australia; Department of Public Health (H.A.), Fukuoka University, Japan; The George Institute for Global Health and Westmead Clinical School (R.L.), University of Sydney, Australia; Faculty of Health and Wellbeing (M.L.H.), The University of Central Lancashire, Preston, UK; Unidad de Neurología Vascular (P.L., P.M.V., V.V.O., A.B.), Servicio de Neurología, Departamento de Neurología y Psiquiatría, Clínica Alemana de Santiago, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago; Departamento de Ciencias Neurológicas (P.L.), Facultad de Medicina, Universidad de Chile; Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Centre (T.G.R.), University of Leicester, UK; Centro de Estudios Clínicos (P.M.V.), Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago; Departamento de Paciente Crítico (V.V.O.), Clínica Alemana de Santiago, Chile; The George Institute for Global Health (M.W.), University of Oxford, UK; Department of Epidemiology (M.W.), Johns Hopkins University, Baltimore, MD; and The George Institute China at Peking University Health Science Centre (C.S.A.), Beijing, China.
Sex differences in treatment and outcome after stroke
Cheryl Carcel, Xia Wang, Else Charlotte Sandset, Candice Delcourt, Hisatomi Arima, Richard Lindley, Maree L. Hackett, Pablo Lavados, Thompson G. Robinson, Paula Muñoz Venturelli, Verónica V. Olavarría, Alejandro Brunser, Eivind Berge, John Chalmers, Mark Woodward, Craig S. Anderson
Neurology Dec 2019, 93 (24) e2170-e2180; DOI: 10.1212/WNL.0000000000008615
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Abstract
Objective To explore the sex differences in outcomes and management after stroke using a large sample with high-quality international trial data.
Methods Individual participant data were obtained from 5 acute stroke randomized controlled trials. Data were obtained on demographics, medication use, in-hospital treatment, and functional outcome. Study-specific crude and adjusted models were used to estimate sex differences in outcomes and management, and then pooled using random-effects meta-analysis.
Results There were 19,652 participants, of whom 7,721 (40%) were women. After multivariable adjustments, women with ischemic stroke had higher survival at 3–6 months (odds ratio [OR] 0.82, 95% confidence interval [CI] 0.70–0.97), higher likelihood of disability (OR 1.20, 95% CI 1.06–1.36), and worse quality of life (weighted mean difference −0.07, 95% CI −0.09 to 0.04). For management, women were more likely to be admitted to an acute stroke unit (OR 1.17, 95% CI 1.01–1.34), but less likely to be intubated (OR 0.58, 95% CI 0.36–0.93), treated for fever (OR 0.82, 95% CI 0.70–0.95), or admitted to an intensive care unit (OR 0.83, 95% CI 0.74–0.93). For preadmission medications, women had higher odds of being prescribed antihypertensive agents (OR 1.22, 95% CI 1.13–1.31) and lower odds of being prescribed antiplatelets (OR 0.86, 95% CI 0.79–0.93), glucose-lowering agents (OR 0.86, 95% CI 0.78–0.94), or lipid-lowering agents (OR 0.85, 95% CI 0.77–0.94).
Conclusions This analysis suggests that women who had ischemic stroke had better survival but were also more disabled and had poorer quality of life. Variations in hospital and out-of-hospital management may partly explain the disparities.
Glossary
- AF=
- atrial fibrillation;
- ASU=
- acute stroke unit;
- BP=
- blood pressure;
- CI=
- confidence interval;
- CV=
- cardiovascular;
- ENCHANTED=
- Enhanced Control of Hypertension and Thrombolysis Stroke study;
- HeadPoST=
- Head Position in Acute Stroke Trial;
- HRQoL=
- health-related quality of life;
- ICH=
- intracerebral hemorrhage;
- ICU=
- intensive care unit;
- INTERACT=
- Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial;
- IPD=
- individual participant data;
- mRS=
- modified Rankin Scale;
- NIHSS=
- NIH Stroke Scale;
- OR=
- odds ratio;
- SCAST=
- Scandinavian Candesartan Acute Stroke Trial;
- SSS=
- Scandinavian Stroke Scale
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.
↵* These authors contributed equally to this work as co–first authors.
Editorial, page 1025
- Received January 30, 2019.
- Accepted in final form July 29, 2019.
- © 2019 American Academy of Neurology
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Disputes & Debates: Rapid online correspondence
- Reader response: Sex differences in treatment and outcome after stroke: Pooled analysis including 19,000 participants
- Aravind Ganesh, Neurology Resident, Stroke Fellow, Department of Clinical Neurosciences, University of Calgary (Calgary, Canada)
- Malavika Varma, Clinical Director, Advanced Health Analytics (AHA Health Ltd) (Calgary, Canada)
Published January 13, 2020
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