Sex Differences in Long-Term Quality of Life Among Survivors After Stroke in the INSTRUCT

Hoang T. Phan, Christopher L. Blizzard, Mathew J. Reeves, Amanda G. Thrift, Dominique A. Cadilhac, Jonathan Sturm, Emma Heeley, Petr Otahal, Peter Rothwell, Craig S. Anderson, Priya Parmar, Rita Krishnamurthi, Suzanne Lyn Barker-Collo, Valery Feigin, Seana Gall

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Background and Purpose- Women are reported to have poorer health-related quality of life (HRQoL) after stroke than men, but the underlying reasons are uncertain. We investigated factors contributing to the sex differences. Methods- Individual participant data on 4288 first-ever strokes (1996-2013) were obtained from 4 high-quality population-based incidence studies from Australasia and Europe. HRQoL utility scores among survivors after stroke (range from negative scores=worse than death to 1=perfect health) were calculated from 3 scales including European Quality of Life-5 Dimensions, Short-Form 6-Dimension, and Assessment of Quality of Life at 1 year (3 studies; n=1210) and 5 years (3 studies; n=1057). Quantile regression was used to estimate the median differences in HRQoL for women compared to men with adjustment for covariates. Study factors included sociodemographics, prestroke dependency, stroke-related factors (eg, stroke severity), comorbidities, and poststroke depression. Study-specific median differences were combined into pooled estimates using random-effect meta-analysis. Results- Women had lower pooled HRQoL than men (median differenceunadjusted 1 year, -0.147; 95% CI, -0.258 to -0.036; 5 years, -0.090; 95% CI, -0.119 to -0.062). After adjustment for age, stroke severity, prestroke dependency, and depression, these pooled median differences were attenuated, more greatly at 1 year (-0.067; 95% CI, -0.111 to -0.022) than at 5 years (-0.085; 95% CI, -0.135 to -0.034). Conclusions- Women consistently exhibited poorer HRQoL after stroke than men. This was partly attributable to women's advanced age, more severe strokes, prestroke dependency, and poststroke depression, suggesting targets to reduce the differences. There was some evidence of residual differences in HRQoL between sexes but they were small and unlikely to be clinically significant.

Original languageEnglish
Pages (from-to)2299-2306
Number of pages8
JournalStroke
Volume50
Issue number9
DOIs
Publication statusPublished - 1 Sep 2019

Keywords

  • comorbidity
  • depression
  • incidence
  • quality of life
  • survivors

Cite this

Phan, Hoang T. ; Blizzard, Christopher L. ; Reeves, Mathew J. ; Thrift, Amanda G. ; Cadilhac, Dominique A. ; Sturm, Jonathan ; Heeley, Emma ; Otahal, Petr ; Rothwell, Peter ; Anderson, Craig S. ; Parmar, Priya ; Krishnamurthi, Rita ; Barker-Collo, Suzanne Lyn ; Feigin, Valery ; Gall, Seana. / Sex Differences in Long-Term Quality of Life Among Survivors After Stroke in the INSTRUCT. In: Stroke. 2019 ; Vol. 50, No. 9. pp. 2299-2306.
@article{01707645e53344eaa126db1eedfc61ba,
title = "Sex Differences in Long-Term Quality of Life Among Survivors After Stroke in the INSTRUCT",
abstract = "Background and Purpose- Women are reported to have poorer health-related quality of life (HRQoL) after stroke than men, but the underlying reasons are uncertain. We investigated factors contributing to the sex differences. Methods- Individual participant data on 4288 first-ever strokes (1996-2013) were obtained from 4 high-quality population-based incidence studies from Australasia and Europe. HRQoL utility scores among survivors after stroke (range from negative scores=worse than death to 1=perfect health) were calculated from 3 scales including European Quality of Life-5 Dimensions, Short-Form 6-Dimension, and Assessment of Quality of Life at 1 year (3 studies; n=1210) and 5 years (3 studies; n=1057). Quantile regression was used to estimate the median differences in HRQoL for women compared to men with adjustment for covariates. Study factors included sociodemographics, prestroke dependency, stroke-related factors (eg, stroke severity), comorbidities, and poststroke depression. Study-specific median differences were combined into pooled estimates using random-effect meta-analysis. Results- Women had lower pooled HRQoL than men (median differenceunadjusted 1 year, -0.147; 95{\%} CI, -0.258 to -0.036; 5 years, -0.090; 95{\%} CI, -0.119 to -0.062). After adjustment for age, stroke severity, prestroke dependency, and depression, these pooled median differences were attenuated, more greatly at 1 year (-0.067; 95{\%} CI, -0.111 to -0.022) than at 5 years (-0.085; 95{\%} CI, -0.135 to -0.034). Conclusions- Women consistently exhibited poorer HRQoL after stroke than men. This was partly attributable to women's advanced age, more severe strokes, prestroke dependency, and poststroke depression, suggesting targets to reduce the differences. There was some evidence of residual differences in HRQoL between sexes but they were small and unlikely to be clinically significant.",
keywords = "comorbidity, depression, incidence, quality of life, survivors",
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 Peter Rothwell and Anderson, {Craig S.} and Priya Parmar and Rita Krishnamurthi and Barker-Collo, {Suzanne Lyn} and Valery Feigin and Seana Gall",
year = "2019",
month = "9",
day = "1",
doi = "10.1161/STROKEAHA.118.024437",
language = "English",
volume = "50",
pages = "2299--2306",
journal = "Stroke",
issn = "0039-2499",
publisher = "American Heart Association",
number = "9",

}

Phan, HT, Blizzard, CL, Reeves, MJ, Thrift, AG, Cadilhac, DA, Sturm, J, Heeley, E, Otahal, P, Rothwell, P, Anderson, CS, Parmar, P, Krishnamurthi, R, Barker-Collo, SL, Feigin, V & Gall, S 2019, 'Sex Differences in Long-Term Quality of Life Among Survivors After Stroke in the INSTRUCT', Stroke, vol. 50, no. 9, pp. 2299-2306. https://doi.org/10.1161/STROKEAHA.118.024437

Sex Differences in Long-Term Quality of Life Among Survivors After Stroke in the INSTRUCT. / Phan, Hoang T.; Blizzard, Christopher L.; Reeves, Mathew J.; Thrift, Amanda G.; Cadilhac, Dominique A.; Sturm, Jonathan; Heeley, Emma; Otahal, Petr; Rothwell, Peter; Anderson, Craig S.; Parmar, Priya; Krishnamurthi, Rita; Barker-Collo, Suzanne Lyn; Feigin, Valery; Gall, Seana.

In: Stroke, Vol. 50, No. 9, 01.09.2019, p. 2299-2306.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Sex Differences in Long-Term Quality of Life Among Survivors After Stroke in the INSTRUCT

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 - Rothwell, Peter

AU - Anderson, Craig S.

AU - Parmar, Priya

AU - Krishnamurthi, Rita

AU - Barker-Collo, Suzanne Lyn

AU - Feigin, Valery

AU - Gall, Seana

PY - 2019/9/1

Y1 - 2019/9/1

N2 - Background and Purpose- Women are reported to have poorer health-related quality of life (HRQoL) after stroke than men, but the underlying reasons are uncertain. We investigated factors contributing to the sex differences. Methods- Individual participant data on 4288 first-ever strokes (1996-2013) were obtained from 4 high-quality population-based incidence studies from Australasia and Europe. HRQoL utility scores among survivors after stroke (range from negative scores=worse than death to 1=perfect health) were calculated from 3 scales including European Quality of Life-5 Dimensions, Short-Form 6-Dimension, and Assessment of Quality of Life at 1 year (3 studies; n=1210) and 5 years (3 studies; n=1057). Quantile regression was used to estimate the median differences in HRQoL for women compared to men with adjustment for covariates. Study factors included sociodemographics, prestroke dependency, stroke-related factors (eg, stroke severity), comorbidities, and poststroke depression. Study-specific median differences were combined into pooled estimates using random-effect meta-analysis. Results- Women had lower pooled HRQoL than men (median differenceunadjusted 1 year, -0.147; 95% CI, -0.258 to -0.036; 5 years, -0.090; 95% CI, -0.119 to -0.062). After adjustment for age, stroke severity, prestroke dependency, and depression, these pooled median differences were attenuated, more greatly at 1 year (-0.067; 95% CI, -0.111 to -0.022) than at 5 years (-0.085; 95% CI, -0.135 to -0.034). Conclusions- Women consistently exhibited poorer HRQoL after stroke than men. This was partly attributable to women's advanced age, more severe strokes, prestroke dependency, and poststroke depression, suggesting targets to reduce the differences. There was some evidence of residual differences in HRQoL between sexes but they were small and unlikely to be clinically significant.

AB - Background and Purpose- Women are reported to have poorer health-related quality of life (HRQoL) after stroke than men, but the underlying reasons are uncertain. We investigated factors contributing to the sex differences. Methods- Individual participant data on 4288 first-ever strokes (1996-2013) were obtained from 4 high-quality population-based incidence studies from Australasia and Europe. HRQoL utility scores among survivors after stroke (range from negative scores=worse than death to 1=perfect health) were calculated from 3 scales including European Quality of Life-5 Dimensions, Short-Form 6-Dimension, and Assessment of Quality of Life at 1 year (3 studies; n=1210) and 5 years (3 studies; n=1057). Quantile regression was used to estimate the median differences in HRQoL for women compared to men with adjustment for covariates. Study factors included sociodemographics, prestroke dependency, stroke-related factors (eg, stroke severity), comorbidities, and poststroke depression. Study-specific median differences were combined into pooled estimates using random-effect meta-analysis. Results- Women had lower pooled HRQoL than men (median differenceunadjusted 1 year, -0.147; 95% CI, -0.258 to -0.036; 5 years, -0.090; 95% CI, -0.119 to -0.062). After adjustment for age, stroke severity, prestroke dependency, and depression, these pooled median differences were attenuated, more greatly at 1 year (-0.067; 95% CI, -0.111 to -0.022) than at 5 years (-0.085; 95% CI, -0.135 to -0.034). Conclusions- Women consistently exhibited poorer HRQoL after stroke than men. This was partly attributable to women's advanced age, more severe strokes, prestroke dependency, and poststroke depression, suggesting targets to reduce the differences. There was some evidence of residual differences in HRQoL between sexes but they were small and unlikely to be clinically significant.

KW - comorbidity

KW - depression

KW - incidence

KW - quality of life

KW - survivors

UR - http://www.scopus.com/inward/record.url?scp=85071711903&partnerID=8YFLogxK

U2 - 10.1161/STROKEAHA.118.024437

DO - 10.1161/STROKEAHA.118.024437

M3 - Article

VL - 50

SP - 2299

EP - 2306

JO - Stroke

JF - Stroke

SN - 0039-2499

IS - 9

ER -