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Sex differences in quality of life after ischemic stroke
Cheryl D Bushnell1, Mathew J Reeves, Xin Zhao
1From Wake Forest School of Medicine (C.D.B.), Department of Neurology and Women's Health Center of Excellence for Leadership, Research, and Education, Winston-Salem, NC; Department of Epidemiology (M.J.R.), Michigan State University, East Lansing; Duke Clinical Research Institute (X.Z., W.P., J.P.-B., L.Z., E.P.), Durham; Duke University School of Nursing (J.P.-B.), Durham, NC; and University of Texas Southwestern (D.O.), Houston.
Objective:
We aimed to compare quality of life (QOL) in women and men after ischemic stroke or TIA, and to determine the incremental impact of demographic, socioeconomic, clinical, and stroke-specific effects on longitudinal QOL.
Methods:
We assessed QOL in patients with ischemic stroke or TIA at 3 and 12 months postdischarge in the Adherence eValuation After Ischemic stroke-Longitudinal Registry using the European Quality of Life-5 Dimensions (EQ-5D) instrument. We generated multivariable linear regression models to evaluate the association between sex and EQ-5D while sequentially adjusting for sociodemographic, clinical, and stroke-related variables. We also used a proportional odds model to assess sex differences in the change in EQ-5D scores from 3 to 12 months.
Results:
A total of 1,370 patients were included, 53.7% male, median age 65 years (interquartile range 56-77 years). Women had significantly lower QOL at 3 months (unadjusted EQ-5D 0.81 in women vs 0.84 in men; p < 0.001) and 12 months (0.83 vs men 0.84; p < 0.001) poststroke. After multivariable adjustment for sociodemographic, clinical, and stroke-related factors, women continued to have lower QOL at 3 months (mean difference -0.036; p = 0.003) and at 12 months (mean difference -0.022; p = 0.046). Women fared worse in the dimensions of mobility, pain/discomfort, and anxiety/depression at 3 and 12 months. There were no sex differences in change in EQ-5D score from 3 to 12 months.
Conclusion:
Women have worse QOL than men up to 12 months after stroke, even after adjusting for important sociodemographic variables, stroke severity, and disability.
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