Factors influencing sex differences in poststroke functional outcome

Area of Science:

• Neurology
• Stroke Research
• Sex Differences in Health

Background:

• Sex disparities in functional outcomes after ischemic stroke are well-documented.
• Understanding the factors contributing to these differences is crucial for targeted interventions.

Purpose of the Study:

• To identify factors that contribute to or modify the sex difference in poststroke functional outcome.
• To investigate the role of demographics, prestroke health, and clinical factors in stroke recovery.

Main Methods:

• Analysis of 439 ischemic stroke cases from the Brain Attack Surveillance in Corpus Christi (BASIC) Project.
• Functional outcome assessed using activities of daily living (ADL)/instrumental ADL scores at 90 days post-stroke.
• Tobit regression used to identify confounding and modifying factors for sex differences.

Main Results:

• Women constituted 51% of the study cohort and exhibited significantly worse functional outcomes (higher ADL/iADL scores) compared to men, even after age adjustment.
• Prestroke function, marital status, cognition, nursing home residence, stroke severity, prior stroke/TIA history, and BMI were associated with worse outcomes in women.
• Stroke severity modified the sex difference, with disparities evident in mild to moderate strokes but not severe ones.

Conclusions:

• While demographic and clinical factors explain a portion of the sex difference in stroke outcomes, 41% remains unexplained.
• Prestroke function was a major contributor to worse outcomes in women.
• Further research is essential to identify modifiable factors that can help reduce the observed sex disparity in stroke recovery.