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 & 9 others Peter Rothwell, Carolina Silva, Manuel Correia, Rui Magalhães, Peter Appelros, Janika Kõrv, Riina Vibo, Cesar Minelli, Seana L. Gall

Research output: Contribution to journalArticleResearchpeer-review

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: RR adjusted 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.

Original languageEnglish
Pages (from-to)e1945-e1953
Number of pages9
JournalNeurology
Volume90
Issue number22
DOIs
Publication statusPublished - 29 May 2018

Cite this

Phan, Hoang T. ; Blizzard, Christopher L. ; Reeves, Mathew J. ; Thrift, Amanda G. ; Cadilhac, Dominique A. ; Sturm, Jonathan ; Heeley, Emma ; Otahal, Petr ; Vemmos, Konstantinos ; Anderson, Craig ; Parmar, Priya ; Krishnamurthi, Rita ; Barker-Collo, Suzanne ; Feigin, Valery ; Bejot, Yannick ; Cabral, Norberto Luiz ; Carolei, Antonio ; Sacco, Simona ; Chausson, Nicolas ; Olindo, Stephane ; Rothwell, Peter ; Silva, Carolina ; Correia, Manuel ; Magalhães, Rui ; Appelros, Peter ; Kõrv, Janika ; Vibo, Riina ; Minelli, Cesar ; Gall, Seana L. / Factors contributing to sex differences in functional outcomes and participation after stroke. In: Neurology. 2018 ; Vol. 90, No. 22. pp. e1945-e1953.
@article{e36ebed035204c0e83e122a906d5d463,
title = "Factors contributing to sex differences in functional outcomes and participation after stroke",
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: RR adjusted 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.",
author = "Phan, {Hoang T.} and Blizzard, {Christopher L.} and Reeves, {Mathew J.} and Thrift, {Amanda G.} and Cadilhac, {Dominique A.} and Jonathan Sturm and Emma Heeley and Petr Otahal and Konstantinos Vemmos and Craig Anderson and Priya Parmar and Rita Krishnamurthi and Suzanne Barker-Collo and Valery Feigin and Yannick Bejot and Cabral, {Norberto Luiz} and Antonio Carolei and Simona Sacco and Nicolas Chausson and Stephane Olindo and Peter Rothwell and Carolina Silva and Manuel Correia and Rui Magalh{\~a}es and Peter Appelros and Janika K{\~o}rv and Riina Vibo and Cesar Minelli and Gall, {Seana L.}",
year = "2018",
month = "5",
day = "29",
doi = "10.1212/WNL.0000000000005602",
language = "English",
volume = "90",
pages = "e1945--e1953",
journal = "Neurology",
issn = "0028-3878",
publisher = "AAN Enterprises",
number = "22",

}

Phan, HT, Blizzard, CL, Reeves, MJ, Thrift, AG, Cadilhac, DA, Sturm, J, Heeley, E, Otahal, P, Vemmos, K, Anderson, C, Parmar, P, Krishnamurthi, R, Barker-Collo, S, Feigin, V, Bejot, Y, Cabral, NL, Carolei, A, Sacco, S, Chausson, N, Olindo, S, Rothwell, P, Silva, C, Correia, M, Magalhães, R, Appelros, P, Kõrv, J, Vibo, R, Minelli, C & Gall, SL 2018, 'Factors contributing to sex differences in functional outcomes and participation after stroke' Neurology, vol. 90, no. 22, pp. e1945-e1953. https://doi.org/10.1212/WNL.0000000000005602

Factors contributing to sex differences in functional outcomes and participation after stroke. / Phan, Hoang T.; Blizzard, Christopher L.; Reeves, Mathew J.; Thrift, Amanda G.; Cadilhac, Dominique A.; Sturm, Jonathan; Heeley, Emma; Otahal, Petr; Vemmos, Konstantinos; Anderson, Craig; Parmar, Priya; Krishnamurthi, Rita; Barker-Collo, Suzanne; Feigin, Valery; Bejot, Yannick; Cabral, Norberto Luiz; Carolei, Antonio; Sacco, Simona; Chausson, Nicolas; Olindo, Stephane; Rothwell, Peter; Silva, Carolina; Correia, Manuel; Magalhães, Rui; Appelros, Peter; Kõrv, Janika; Vibo, Riina; Minelli, Cesar; Gall, Seana L.

In: Neurology, Vol. 90, No. 22, 29.05.2018, p. e1945-e1953.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Factors contributing to sex differences in functional outcomes and participation after stroke

AU - Phan, Hoang T.

AU - Blizzard, Christopher L.

AU - Reeves, Mathew J.

AU - Thrift, Amanda G.

AU - Cadilhac, Dominique A.

AU - Sturm, Jonathan

AU - Heeley, Emma

AU - Otahal, Petr

AU - Vemmos, Konstantinos

AU - Anderson, Craig

AU - Parmar, Priya

AU - Krishnamurthi, Rita

AU - Barker-Collo, Suzanne

AU - Feigin, Valery

AU - Bejot, Yannick

AU - Cabral, Norberto Luiz

AU - Carolei, Antonio

AU - Sacco, Simona

AU - Chausson, Nicolas

AU - Olindo, Stephane

AU - Rothwell, Peter

AU - Silva, Carolina

AU - Correia, Manuel

AU - Magalhães, Rui

AU - Appelros, Peter

AU - Kõrv, Janika

AU - Vibo, Riina

AU - Minelli, Cesar

AU - Gall, Seana L.

PY - 2018/5/29

Y1 - 2018/5/29

N2 - Objective: To examine factors contributing to the sex differences in functional outcomes and participation restriction after stroke. Methods: Individual participant data on long-term functional outcome or participation restriction (i.e., handicap) were obtained from 11 stroke incidence studies (1993-2014). Multivariable log-binomial regression was used to estimate the female:male relative risk (RR) of poor functional outcome (modified Rankin Scale score >2 or Barthel Index score <20) at 1 year (10 studies, n = 4,852) and 5 years (7 studies, n = 2,226). Multivariable linear regression was used to compare the mean difference (MD) in participation restriction by use of the London Handicap Scale (range 0-100 with lower scores indicating poorer outcome) for women compared to men at 5 years (2 studies, n = 617). For each outcome, study-specific estimates adjusted for confounding factors (e.g., sociodemographics, stroke-related factors) were combined with the use of random-effects meta-analysis. Results: In unadjusted analyses, women experienced worse functional outcomes after stroke than men (1 year: pooled 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: RR adjusted 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.

AB - 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: RR adjusted 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.

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U2 - 10.1212/WNL.0000000000005602

DO - 10.1212/WNL.0000000000005602

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VL - 90

SP - e1945-e1953

JO - Neurology

JF - Neurology

SN - 0028-3878

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