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

Given the growing number of US stroke survivors, especially female survivors, understanding contemporary trajectories of stroke outcomes by sex is crucial. Yet, such data are rare. We estimated sex-specific changes in poststroke functional, neurologic, quality of life, and cognitive outcomes.

This cohort study included first-ever ischemic strokes (ISs) ascertained from the Brain Attack Surveillance in Corpus Christi Project (south Texas, 2014-2019). Data were from medical records (e.g., age, sex) and interviews (baseline, 3, 6, and 12 months after stroke), including functional (activities of daily living/instrumental activities of daily living score [ADL/IADL]), neurologic (NIH Stroke Scale), quality of life (abbreviated Stroke-specific Quality of Life scale), and cognitive (Modified Mini-Mental State Examination [3MSE]) outcomes. Multivariable adjusted linear mixed effects models including interactions between sex and time were used to estimate sex differences at each time point and sex-specific changes in outcomes.

Among the 1,046 IS (mean age 66, 47.6% female survivors), female survivors had higher adjusted mean ADL/IADL scores than male survivors at 3, 6, and 12 months, despite a decrease in ADL/IADL scores from 3 to 12 months only among female survivors (adjusted mean difference in ADL/IADL scores -0.08, 95% CI -0.14 to -0.03). While no significant sex differences were observed for other outcomes, both sexes experienced an improvement in neurologic outcome, and an improvement in cognition was only found among male survivors (adjusted mean difference in 3MSE scores 0.97, 95% CI 0.09-1.85). Improvements were primarily driven by recoveries from 3 to 6 months.

Female survivors had worse functional outcome but not other outcomes than male survivors up to 12 months after stroke. Although outcomes generally continued improving after 3 months poststroke for both sexes, the recovery pattern differed by sex. These results suggest that early and continued assessments of functional outcome after stroke may be needed, particularly for female survivors to reduce the sex differences, and that future interventions designed to improve outcomes in the chronic phase of stroke should consider the sex-specific recovery patterns. The generalizability may be limited by our single community study population, and results should be replicated in other populations.