Sex differences in baseline characteristics, stroke care, and outcomes across socioeconomic settings: a multicentre...

While stroke risk and burden vary across Europe, the combined impact of sex and socioeconomic context on stroke care and recovery remains poorly understood.

This observational multicentre cohort study analyzed prospectively collected registry data from patients with acute ischemic stroke from three tertiary care hospitals in different socioeconomic settings: Bern/Switzerland (high-income region; women = 128/293(43.7%)), Gdansk/Poland (high-income region; women = 54/139(38.8%)), and Lutsk/Ukraine (low-income region; women = 86/188(45.7%)).

We analyzed the data of 620 patients (median age CH-W/M:77.4/71.2;PL-W/M:75.5/67.0;UA-W/M:73.0/67.0;p-all = 0.051/p-W = 0.434/p-M = 0.130) admitted between 7 and 12/2019. There were significant differences between countries in women's pre-stroke mRS: 0-1 (women: Switzerland: 73.6%/Poland: 62.9%; p-all/women < 0.001) and BMI (women: Switzerland: 24.2/Poland: 27.9/Ukraine: 29.3; p-women < 0.001). Stroke severity differed overall and between sexes (median NIHSS women: Switzerland: 4/Poland: 13/Ukraine: 7, men: Switzerland: 4/Poland: 9/Ukraine: 7; p-all < 0.001; p-women/men = 0.005). Atrial fibrillation was more common in women (women: Switzerland: 31.3%/Poland: 57.4%/Ukraine: 47.7%) vs. men (men: Switzerland: 26.1%/Poland: 31.8%/Ukraine: 32.4%; p-all = 0.006/p-women = 0.002), as was arterial hypertension (p-all/women/men < 0.001), with the highest rates in Ukraine (all: 87.2%). Smoking status differed significantly overall (p-all < 0.001), with the lowest rates in Ukrainian women (never smokers: 96.5%) and highest in Swiss men (active smokers: 40.7%). Initial neuroimaging differed significantly by country, with the highest MRI use in Swiss women (women: Switzerland: 49.6%/Poland: 14.8%/Ukraine: 16.3%), highest CT use in Ukrainian men (men: Switzerland: 25.8%/Poland: 45.9%/Ukraine: 72.5%) and lowest use of both modalities in Ukraine (p-all/women/men < 0.001). Therapy (IVT/EVT/craniectomy/conservative) also differed significantly (p-all/women/men < 0.001), with conservative therapy most common in Ukraine (women: 96.5%/men: 94.1%). 3-month excellent outcome was significantly higher in Swiss vs. Ukrainian women (adjusted-OR-Swiss-Ukrainian-women = 2.96; adjusted-p-women = 0.015). 3-month mortality did not differ significantly. 3-month smoking rates were higher in Switzerland vs. Ukraine (adjusted-OR-Swiss-Ukrainian-women = 9; adjusted-p-Swiss-Ukrainian-women = 0.05; adjusted-OR-Swiss-Ukrainian-men = 9.75; adjusted-p-Swiss-Ukrainian-men = 0.004).

Swiss versus Ukrainian women were three times more likely to achieve excellent 3-month outcomes, associated with disparities in prevention strategies. These findings highlight the need for sex-, gender-, and socioeconomic-specific approaches to stroke prevention, with tailored interventions to reduce inequalities.