Reader Response: Biological Sex Differences in Risk Factors and Outcomes Among Hospitalized Adults With Stroke in Lusaka, Zambia
Emma D.Frost, Medical Student, Cooper Medical School of Rowan University
James E.Siegler, Director, Comprehensive Stroke Program, NeuroHospitalist, Cooper University Hospital
Submitted February 02, 2023
We read with interest the results of this retrospective cohort study that showed several differences in clinical characteristics and outcomes of Zambian patients with stroke, when stratified by sex.1 It is alarming that female patients underwent less neuroimaging (with subsequently less confirmation of ischemic or hemorrhagic stroke) and had a two-fold higher 90-day mortality rate when compared to male stroke patients (adjusted OR 2.48, 95%CI 1.1-5.58).
Due to the cross-sectional, observational nature of the study, there is no explicit reason as to why females tend to have poorer outcomes following stroke, the authors comment that social factors play a role. For example, women serving as care providers for children and family members may deprioritize their own health, while men tend to be the sole source of financial support for their family, and therefore their health is given higher priority. That said, women had numerically higher rates of pre-stroke hypertension, diabetes, dyslipidemia, heart disease, prior stroke, and atrial fibrillation compared to men. Females may lack funds for medical care, yet more of them harbor these pre-existing conditions.
Can the investigators comment on whether females are as likely to receive treatment for these conditions as their male counterparts? Disparities in treatment may support the social argument for this imbalance in stroke-related outcomes between sexes.
References
1. Nutakki A, Chomba M, Chishimba LC, Zimba S, Gottesman RF, Bahouth MN, Saylor DR. Biological Sex Differences in Risk Factors and Outcomes Among Hospitalized Adults With Stroke in Lusaka, Zambia. Neurology. 2022 Dec 19:10.1212/WNL.0000000000201696. doi: 10.1212/WNL.0000000000201696. Epub ahead of print. PMID: 36535774.
2.Bruce SS, Merkler AE, Bassi M, et al. (2020). Differences in diagnostic evaluation in women and men after acute ischemic stroke. Journal of the American Heart Association; 2020:9(5), e015625.
Author disclosures are available upon request(journal@neurology.org).
We read with interest the results of this retrospective cohort study that showed several differences in clinical characteristics and outcomes of Zambian patients with stroke, when stratified by sex.1 It is alarming that female patients underwent less neuroimaging (with subsequently less confirmation of ischemic or hemorrhagic stroke) and had a two-fold higher 90-day mortality rate when compared to male stroke patients (adjusted OR 2.48, 95%CI 1.1-5.58).
Due to the cross-sectional, observational nature of the study, there is no explicit reason as to why females tend to have poorer outcomes following stroke, the authors comment that social factors play a role. For example, women serving as care providers for children and family members may deprioritize their own health, while men tend to be the sole source of financial support for their family, and therefore their health is given higher priority. That said, women had numerically higher rates of pre-stroke hypertension, diabetes, dyslipidemia, heart disease, prior stroke, and atrial fibrillation compared to men. Females may lack funds for medical care, yet more of them harbor these pre-existing conditions.
Can the investigators comment on whether females are as likely to receive treatment for these conditions as their male counterparts? Disparities in treatment may support the social argument for this imbalance in stroke-related outcomes between sexes.
References
1. Nutakki A, Chomba M, Chishimba LC, Zimba S, Gottesman RF, Bahouth MN, Saylor DR. Biological Sex Differences in Risk Factors and Outcomes Among Hospitalized Adults With Stroke in Lusaka, Zambia. Neurology. 2022 Dec 19:10.1212/WNL.0000000000201696. doi: 10.1212/WNL.0000000000201696. Epub ahead of print. PMID: 36535774.
2.Bruce SS, Merkler AE, Bassi M, et al. (2020). Differences in diagnostic evaluation in women and men after acute ischemic stroke. Journal of the American Heart Association; 2020:9(5), e015625.
Author disclosures are available upon request(journal@neurology.org).