Sex Differences in Outcome Measures After Stroke

Gall S, Phan H, Madsen TE, et al.
Focused Update of Sex Differences in Patient Reported Outcome Measures After Stroke. Stroke 2018;Feb 8:[Epub ahead of print].

The following are key points to remember from this focused update of sex differences in patient-reported outcome measures after stroke:

  1. Numerous studies have shown that women have worse outcomes after stroke than men.
  2. Some of the disparity in outcomes may be driven by women’s older age at the time of stroke, greater stroke severity, and poorer prestroke function. However, other potential contributing factors should be examined.
  3. This short review describes the results of 22 studies published from 2007 onwards that examine sex differences in patient-reported outcome measures at ≤12 months after stroke.
  4. Activity limitation (as measured by a poor outcome on the modified Rankin scale or Barthel Index) was more prevalent in women than men after both ischemic stroke and combined ischemic/hemorrhagic stroke. Some, but not all, of the difference between men and women was explained by women’s older age at time of stroke, greater stroke severity, comorbidities, and poorer prestroke function.
  5. Women appear to have worse health-related quality of life after stroke than men, though some of this difference may be explained by post-stroke depression and worse post-stroke functional outcome.
  6. Women appear more likely to have post-stroke depression than men, even after adjustment for age, stroke severity, and activity limitation. Post-stroke depression may have a bidirectional relationship with other post-stroke outcome measures, such as health-related quality of life and activity limitation.
  7. It remains unclear whether there are sex differences in cognitive impairment after stroke.
  8. Future studies of post-stroke outcomes in women should focus on modifiable factors contributing to sex differences. These studies should include potential confounding factors such as social isolation and loneliness, socioeconomic status, and measures of mental health.

Clinical Topics: Prevention

Keywords: Comorbidity, Depression, Intracranial Hemorrhages, Loneliness, Mental Health, Outcome Assessment (Health Care), Prevalence, Quality of Life, Secondary Prevention, Sex Characteristics, Social Class, Social Isolation, Stroke, Vascular Diseases, Women

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