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 language | English |
|---|---|
| Pages (from-to) | 712-720 |
| Number of pages | 9 |
| Journal | Journal of Women's Health |
| Volume | 28 |
| Issue number | 5 |
| DOIs | |
| Publication status | Published - 1 May 2019 |
Keywords
- mortality
- quality of care
- sex difference
- stroke
Cite this
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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 journal › Article › Research › peer-review
TY - JOUR
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
UR - http://www.scopus.com/inward/record.url?scp=85065862066&partnerID=8YFLogxK
U2 - 10.1089/jwh.2018.7171
DO - 10.1089/jwh.2018.7171
M3 - Article
VL - 28
SP - 712
EP - 720
JO - Journal of Women's Health
JF - Journal of Women's Health
SN - 1540-9996
IS - 5
ER -