Sex Differences in Care and Long-Term Mortality after Stroke

Australian Stroke Clinical Registry

Hoang T. Phan, Seana L. Gall, Christopher L. Blizzard, Natasha A. Lannin, Amanda G. Thrift, Craig S. Anderson, Joosup Kim, Rohan Grimley, Helen C. Castley, Peter Hand, Dominique A. Cadilhac, on behalf of the AuSCR Consortium

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Introduction: There is some evidence that women receive evidence-based care less often than men, but how this influences long-term mortality after stroke is unclear. We explored this issue using data from a national stroke registry. Materials and Methods: Data are first-ever hospitalized strokes (2010-2014) in the Australian Stroke Clinical Registry from 39 hospitals linked to the national death registrations. Multilevel Poisson regression was used to estimate the women:men mortality rate ratio (MRR), with adjustment for sociodemographics, stroke severity, and processes of care (stroke unit care, intravenous thrombolysis, antihypertensive agent[s], and discharge care plan). Results: Among 14,118 events (46% females), women were 7 years older and had greater baseline severity compared to men (29% vs. 37%; p < 0.001), but there were no differences in the four processes of care available across hospitals. In the whole cohort, 1-year mortality was greater in women than men (MRR unadjusted 1.44, 95% confidence interval [CI] 1.34-1.54). However, there were no differences after adjusting for age and stroke severity (MRR adjusted 1.03, 95% CI 0.95-1.10). In analyses of additional processes from Queensland hospitals (n=5224), women were less often administered aspirin ≤48 hours (61% vs. men 69%, p < 0.015). In Queensland hospitals, there were no statistically significant sex differences in 1-year mortality after adjusting for age, stroke severity, and early administration of aspirin. Conclusion: Greater mortality in women can be explained by differences in age and stroke severity. This highlights the importance of better management of risk factors in the elderly and, potentially, the need for greater access to early aspirin for women with stroke.

Original languageEnglish
Pages (from-to)712-720
Number of pages9
JournalJournal of Women's Health
Volume28
Issue number5
DOIs
Publication statusPublished - 1 May 2019

Keywords

  • mortality
  • quality of care
  • sex difference
  • stroke

Cite this

Phan, Hoang T. ; Gall, Seana L. ; Blizzard, Christopher L. ; Lannin, Natasha A. ; Thrift, Amanda G. ; Anderson, Craig S. ; Kim, Joosup ; Grimley, Rohan ; Castley, Helen C. ; Hand, Peter ; Cadilhac, Dominique A. ; on behalf of the AuSCR Consortium. / Sex Differences in Care and Long-Term Mortality after Stroke : Australian Stroke Clinical Registry. In: Journal of Women's Health. 2019 ; Vol. 28, No. 5. pp. 712-720.
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title = "Sex Differences in Care and Long-Term Mortality after Stroke: Australian Stroke Clinical Registry",
abstract = "Introduction: There is some evidence that women receive evidence-based care less often than men, but how this influences long-term mortality after stroke is unclear. We explored this issue using data from a national stroke registry. Materials and Methods: Data are first-ever hospitalized strokes (2010-2014) in the Australian Stroke Clinical Registry from 39 hospitals linked to the national death registrations. Multilevel Poisson regression was used to estimate the women:men mortality rate ratio (MRR), with adjustment for sociodemographics, stroke severity, and processes of care (stroke unit care, intravenous thrombolysis, antihypertensive agent[s], and discharge care plan). Results: Among 14,118 events (46{\%} females), women were 7 years older and had greater baseline severity compared to men (29{\%} vs. 37{\%}; p < 0.001), but there were no differences in the four processes of care available across hospitals. In the whole cohort, 1-year mortality was greater in women than men (MRR unadjusted 1.44, 95{\%} confidence interval [CI] 1.34-1.54). However, there were no differences after adjusting for age and stroke severity (MRR adjusted 1.03, 95{\%} CI 0.95-1.10). In analyses of additional processes from Queensland hospitals (n=5224), women were less often administered aspirin ≤48 hours (61{\%} vs. men 69{\%}, p < 0.015). In Queensland hospitals, there were no statistically significant sex differences in 1-year mortality after adjusting for age, stroke severity, and early administration of aspirin. Conclusion: Greater mortality in women can be explained by differences in age and stroke severity. This highlights the importance of better management of risk factors in the elderly and, potentially, the need for greater access to early aspirin for women with stroke.",
keywords = "mortality, quality of care, sex difference, stroke",
author = "Phan, {Hoang T.} and Gall, {Seana L.} and Blizzard, {Christopher L.} and Lannin, {Natasha A.} and Thrift, {Amanda G.} and Anderson, {Craig S.} and Joosup Kim and Rohan Grimley and Castley, {Helen C.} and Peter Hand and Cadilhac, {Dominique A.} and {on behalf of the AuSCR Consortium}",
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Phan, HT, Gall, SL, Blizzard, CL, Lannin, NA, Thrift, AG, Anderson, CS, Kim, J, Grimley, R, Castley, HC, Hand, P, Cadilhac, DA & on behalf of the AuSCR Consortium 2019, 'Sex Differences in Care and Long-Term Mortality after Stroke: Australian Stroke Clinical Registry', Journal of Women's Health, vol. 28, no. 5, pp. 712-720. https://doi.org/10.1089/jwh.2018.7171

Sex Differences in Care and Long-Term Mortality after Stroke : Australian Stroke Clinical Registry. / Phan, Hoang T.; Gall, Seana L.; Blizzard, Christopher L.; Lannin, Natasha A.; Thrift, Amanda G.; Anderson, Craig S.; Kim, Joosup; Grimley, Rohan; Castley, Helen C.; Hand, Peter; Cadilhac, Dominique A.; on behalf of the AuSCR Consortium.

In: Journal of Women's Health, Vol. 28, No. 5, 01.05.2019, p. 712-720.

Research output: Contribution to journalArticleResearchpeer-review

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T1 - Sex Differences in Care and Long-Term Mortality after Stroke

T2 - Australian Stroke Clinical Registry

AU - Phan, Hoang T.

AU - Gall, Seana L.

AU - Blizzard, Christopher L.

AU - Lannin, Natasha A.

AU - Thrift, Amanda G.

AU - Anderson, Craig S.

AU - Kim, Joosup

AU - Grimley, Rohan

AU - Castley, Helen C.

AU - Hand, Peter

AU - Cadilhac, Dominique A.

AU - on behalf of the AuSCR Consortium

PY - 2019/5/1

Y1 - 2019/5/1

N2 - Introduction: There is some evidence that women receive evidence-based care less often than men, but how this influences long-term mortality after stroke is unclear. We explored this issue using data from a national stroke registry. Materials and Methods: Data are first-ever hospitalized strokes (2010-2014) in the Australian Stroke Clinical Registry from 39 hospitals linked to the national death registrations. Multilevel Poisson regression was used to estimate the women:men mortality rate ratio (MRR), with adjustment for sociodemographics, stroke severity, and processes of care (stroke unit care, intravenous thrombolysis, antihypertensive agent[s], and discharge care plan). Results: Among 14,118 events (46% females), women were 7 years older and had greater baseline severity compared to men (29% vs. 37%; p < 0.001), but there were no differences in the four processes of care available across hospitals. In the whole cohort, 1-year mortality was greater in women than men (MRR unadjusted 1.44, 95% confidence interval [CI] 1.34-1.54). However, there were no differences after adjusting for age and stroke severity (MRR adjusted 1.03, 95% CI 0.95-1.10). In analyses of additional processes from Queensland hospitals (n=5224), women were less often administered aspirin ≤48 hours (61% vs. men 69%, p < 0.015). In Queensland hospitals, there were no statistically significant sex differences in 1-year mortality after adjusting for age, stroke severity, and early administration of aspirin. Conclusion: Greater mortality in women can be explained by differences in age and stroke severity. This highlights the importance of better management of risk factors in the elderly and, potentially, the need for greater access to early aspirin for women with stroke.

AB - Introduction: There is some evidence that women receive evidence-based care less often than men, but how this influences long-term mortality after stroke is unclear. We explored this issue using data from a national stroke registry. Materials and Methods: Data are first-ever hospitalized strokes (2010-2014) in the Australian Stroke Clinical Registry from 39 hospitals linked to the national death registrations. Multilevel Poisson regression was used to estimate the women:men mortality rate ratio (MRR), with adjustment for sociodemographics, stroke severity, and processes of care (stroke unit care, intravenous thrombolysis, antihypertensive agent[s], and discharge care plan). Results: Among 14,118 events (46% females), women were 7 years older and had greater baseline severity compared to men (29% vs. 37%; p < 0.001), but there were no differences in the four processes of care available across hospitals. In the whole cohort, 1-year mortality was greater in women than men (MRR unadjusted 1.44, 95% confidence interval [CI] 1.34-1.54). However, there were no differences after adjusting for age and stroke severity (MRR adjusted 1.03, 95% CI 0.95-1.10). In analyses of additional processes from Queensland hospitals (n=5224), women were less often administered aspirin ≤48 hours (61% vs. men 69%, p < 0.015). In Queensland hospitals, there were no statistically significant sex differences in 1-year mortality after adjusting for age, stroke severity, and early administration of aspirin. Conclusion: Greater mortality in women can be explained by differences in age and stroke severity. This highlights the importance of better management of risk factors in the elderly and, potentially, the need for greater access to early aspirin for women with stroke.

KW - mortality

KW - quality of care

KW - sex difference

KW - stroke

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U2 - 10.1089/jwh.2018.7171

DO - 10.1089/jwh.2018.7171

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JO - Journal of Women's Health

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