Sex Differences in Outcomes Over the First Year After Ischemic Stroke: A Population-Based Longitudinal Study.

Area of Science:

• Neurology
• Public Health
• Gerontology

Background:

• Stroke is a leading cause of death and disability in the US.
• Understanding sex-specific stroke outcomes is crucial due to the increasing number of female survivors.
• Contemporary data on post-stroke recovery trajectories by sex are limited.

Purpose of the Study:

• To estimate sex-specific changes in functional, neurologic, quality of life, and cognitive outcomes after ischemic stroke.
• To identify differences in stroke recovery patterns between male and female survivors.

Main Methods:

• Cohort study of first-ever ischemic strokes (IS) from 2014-2019.
• Data collected via medical records and interviews at baseline, 3, 6, and 12 months post-stroke.
• Outcomes assessed included activities of daily living/instrumental activities of daily living (ADL/IADL), NIH Stroke Scale, Stroke-Specific Quality of Life scale, and Modified Mini-Mental State Examination (3MSE).
• Multivariable adjusted linear mixed-effects models with sex-time interactions were used.

Main Results:

• Among 1,046 IS survivors (47.6% female), female survivors had worse adjusted mean ADL/IADL scores at 3, 6, and 12 months.
• Female survivors showed a decrease in ADL/IADL scores from 3 to 12 months, unlike males.
• Both sexes improved neurologically; only males showed cognitive improvement (3MSE).
• Improvements were mainly observed between 3 and 6 months post-stroke.

Conclusions:

• Female stroke survivors experienced worse functional outcomes up to 12 months compared to males.
• Stroke recovery patterns differ by sex, with distinct trajectories for functional and cognitive outcomes.
• Early and continued functional assessments, especially for females, are recommended.
• Future interventions should consider sex-specific recovery patterns for improved chronic stroke care.