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

Phan, HT ORCID: 0000-0003-0506-2924, Blizzard, CL ORCID: 0000-0002-9541-6943, Reeves, MJ, Thrift, AG, Cadilhac, DAC, Sturm, J, Heeley, E, Otahal, P ORCID: 0000-0003-4042-1769, 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, Magalhaes, R, Appelros, P, Korv, J, Vibo, R, Minelli, C and Gall, SL ORCID: 0000-0002-5138-2526 2018 , 'Factors contributing to sex differences in functional outcomes and participation after stroke' , Neurology, vol. 90, no. 22 , pp. 1-9 , doi: 10.1212/WNL.0000000000005602.

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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 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: RRadjusted 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.

Item Type: Article
Authors/Creators:Phan, HT and Blizzard, CL and Reeves, MJ and Thrift, AG and Cadilhac, DAC and Sturm, J and Heeley, E and Otahal, P and Vemmos, K and Anderson, C and Parmar, P and Krishnamurthi, R and Barker-Collo, S and Feigin, V and Bejot, Y and Cabral, NL and Carolei, A and Sacco, S and Chausson, N and Olindo, S and Rothwell, P and Silva, C and Correia, M and Magalhaes, R and Appelros, P and Korv, J and Vibo, R and Minelli, C and Gall, SL
Keywords: stroke, functional outcome, sex difference
Journal or Publication Title: Neurology
Publisher: Lippincott Williams & Wilkins
ISSN: 0028-3878
DOI / ID Number: 10.1212/WNL.0000000000005602
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Copyright © 2018 American Academy of Neurology

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