Sex Differences in Stroke in a Sri Lankan Cohort

Area of Science:

• Neurology
• Public Health
• Epidemiology

Background:

• Stroke presentation and risk factors can differ between sexes.
• Limited data exists on sex differences in stroke within South Asian developing countries.
• This study addresses this gap by examining sex disparities in stroke patients in Sri Lanka.

Purpose of the Study:

• To describe and compare sex differences in stroke demographics, clinical presentation, risk factors, and outcomes.
• To identify specific characteristics associated with stroke in women versus men in a Sri Lankan tertiary care setting.

Main Methods:

• A 3-year prospective study (2020-2023) of consecutive stroke patients (n=949) in the Ragama Stroke Registry.
• Comparison of sex differences in demographics, delays, clinical features, subtypes, risk factors, severity, and functional outcomes using statistical tests.
• Multivariate logistic regression analyzed associations with early functional dependence.

Main Results:

• Women (40.8%) were older (median 66 vs. 63 years) and had more ischemic strokes (85.8% vs. 78.6%).
• Women experienced more swallowing difficulty and bladder issues; men had more dysarthria and cerebellar signs.
• Hypertension and diabetes were more prevalent in women; smoking and alcohol use were predominantly in men. No sex differences in admission delays or thrombolysis rates were observed. More men received stroke unit care. Stroke severity and subtypes were similar, but more women had poor functional outcomes at discharge (BI <60), though not independently associated.
• In-hospital mortality was identical between sexes (5.9%).

Conclusions:

• Women stroke patients in this Sri Lankan cohort were older with unique risk factor profiles and clinical characteristics, notably a higher rate of ischemic strokes.
• Despite differences in presentation and risk factors, female sex was not an independent predictor of functional disability or in-hospital mortality.
• Findings highlight the need for sex-specific considerations in stroke care and research, particularly in developing regions.