Sex Differences in Stroke Care and Outcomes: A National Stroke Registry Study

Previous evidence on sex differences in stroke care and outcomes was limited in sample representativeness and coverage of care indicators. We aim to investigate various indicators of stroke care quality, survival, and functional outcome at discharge between men and women, using a national stroke registry.

Ten key indicators, representative from across stroke care pathway, were compared between men and women using the Sentinel Stroke National Audit Programme, a national quality register for England, Wales, and Northern Ireland (2013-2023, n=844 970). Multivariable Poisson regression models with robust variance were constructed to estimated adjusted relative risks (ARR). The 1-year adjusted hazard ratios (AHR) of mortality were conducted using adjusted restricted mean survival time. Favorable functional outcomes at discharge were measured using modified Rankin Scale (0-2).

Women comprised 48% of the study population, mean age 77 years (SD: 13.4) compared with 72 years (13.3) for men. Compared with men, women tend to have severe strokes (19% versus 12%), lower prevalence of diabetes (20% versus 24%), and higher prevalence of atrial fibrillation (21% versus 18%) but similar stroke types (ischemic: 87% versus 88%). Women were less likely to have thrombolysis of arrival <1 hour, brain scan <1 hour, thrombolysis of stroke onset <4 hours, swallowing screen <4 hours, admission to stroke unit <4 hours, assessed by trained nurses <24 hours, assessed by occupational therapist <72 hours, and communication speech and language therapy <72 hours. Women tended to have poorer functional outcome at discharge (ARR, 1.06 [95% CI, 1.05-1.06]) but better 1-year survival (AHR, 0.99 [95% CI, 0.98-0.99]).

Women were less likely to receive several indicators of evidence-based stroke care compared with men. Although they had better survival, functional outcome was poorer in women.