Sex differences in vascular risk factors, in‐hospital management, and outcomes of patients with acute ischemic stroke in China

• Published in: European journal of neurology Vol. 29; no. 1; pp. 188 - 198
• Main Authors: Gu, Hong‐Qiu, Wang, Chun‐Juan, Yang, Xin, Liu, Chelsea, Wang, Xia, Zhao, Xing‐Quan, Wang, Yi‐Long, Liu, Li‐Ping, Meng, Xia, Jiang, Yong, Li, Hao, Wang, Yong‐Jun, Li, Zi‐Xiao
• Format: Journal Article
• Language: English
• Published: England John Wiley & Sons, Inc 01.01.2022
• Subjects: Diabetes mellitus; Disabilities; Fibrillation; Gender aspects; Gender differences; guideline‐adherence; Hypertension; Ischemia; ischemic stroke; Men; Patients; Quality of care; quality of care outcome and process assessment; Risk analysis; Risk assessment; Risk factors; Risk management; Sex differences; Stroke; Women; women and minorities; China; women and minorities; guideline-adherence; quality of care outcome and process assessment; ischemic stroke
• ISSN: 1351-5101; 1468-1331
• DOI: 10.1111/ene.15124

Background Previous assessments of sex differences for patients with acute ischemic stroke were limited in a specific region or population, narrow scope, or small sample size. Methods Patients with acute ischemic stroke hospitalized in the China Stroke Center Alliance hospitals were analyzed. Absolute standardized differences (ASDs) were used to assess sex differences in vascular risk factors, guideline‐recommended in‐hospital management measures and outcomes, including stroke severity (National Institutes of Health Stroke Scale≥16), death/discharge against medical advice, major adverse cardiovascular events, pneumonia, and disability (modified Rankin Scale≥3). Results Of 838,229 patients analyzed, 524351 (62.6%) were men and 313,878 (37.4%) were women. Compared with men, women were older (68.6 vs. 64.7 years), had higher prevalence of hypertension (67.7% vs. 62.4%), diabetes (24.7% vs. 19.5%), and atrial fibrillation (7.1% vs. 4.3%), but lower prevalence of smoking (4.5% vs. 56.6%) and drinking (2.6% vs 35.8%) (ASDs >10%). No sex differences were seen in guideline‐directed management measures, indicated by risk‐adjusted individual measures and the all‐or‐null summary measure (34.5% vs 34.9%, ASD = 1.0%). Compared to men, women tended to have strokes that were more severe at presentation (6.5% vs. 4.5%, ASD = 8.8%) and more disabilities at discharge (34.9% vs 30.5%, ASD =9.4%). However, all sex‐related differences in outcomes were attenuated to null after risk adjustments (ASDs<2%). Conclusions Compared to male patients, female patients had more vascular risk factors and received similar in‐hospital care. They had strokes that were more severe at presentation and more disabilities at discharge, both of which may be explained by worse vascular risk profiles. The figure named as "Graphic "Using nationwide, hospital‐based, consecutively recruited, and rigorously assessed registry data from 1476 hospitals, we systematically evaluated the sex differences in vascular risk factors, in‐hospital management, and outcomes of patients with acute ischemic strokes in China. We found female patients had a higher prevalence of hypertension, diabetes mellitus, and atrial fibrillation. No differences were observed for guideline‐recommended in‐hospital management measures. Compared to men, women tended to have strokes that are more severe and more disabilities at discharge, which may be explained by sex differences in vascular profiles.