Age- and Sex-Specific Risk Profiles and In-Hospital Mortality in 13,932 Spanish Stroke Patients

Area of Science:

• Neurology
• Public Health
• Geriatrics

Background:

• In-hospital stroke death rates remain a significant public health concern, despite advancements in acute stroke management.
• Aging populations and sex-based mortality differences necessitate a deeper understanding of age- and sex-related disparities in stroke care.
• Optimizing post-acute clinical care requires investigating these specific differences.

Purpose of the Study:

• To analyze sex- and age-related differences in in-hospital mortality among ischemic stroke patients.
• To identify factors influencing differential mortality between male and female stroke patients across age groups.

Main Methods:

• A cohort follow-up study involving 13,932 ischemic stroke patients from 19 Spanish hospitals.
• Exclusion of transient ischemic attacks and patients under 18 years old.
• Univariate and multivariable logistic regression analyses comparing male and female cohorts within and across age groups.

Main Results:

• Women were older, more likely to have cardio-embolic etiology, and less likely to receive stroke unit care or have stroke codes activated.
• Stroke severity (NIHSS) was the primary predictor of in-hospital mortality for both sexes.
• While no significant sex differences were found within age groups, overall in-hospital mortality was higher in women due to confounding factors.

Conclusions:

• Age-related sex differences in stroke mortality are significant and must be considered to avoid misleading clinical decisions.
• Improved early management, including timely stroke code activation and access to stroke units/revascularization, is vital for older women.
• Death in women was more directly related to stroke and occurred earlier compared to men.