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Published on: August 11, 2023
Sex Differences in Young Adult Stroke Severity Using Linked Colorado-All Payer's Claims Database and the Get With The
Michelle H Leppert1,2,3, Sharon Scarbro4, Marcelo C Perraillon5
1Department of Neurology University of Colorado School of Medicine Aurora CO USA.
Background:
More young women than men experience first-time strokes. This may be from improved detection of milder severity strokes in young women, as they are more likely to present with nondebilitating neurologic symptoms than men.
Methods:
The objective was to examine sex differences in stroke severity among young adults. Young adults (18-55) with index stroke (January 1, 2012-April 3, 2019) were identified, using Colorado All Payer's Claims Database and linked to the GWTG (Get With The Guidelines)-Stroke Registry. Records were reviewed based on 5/5 linked identifiers (±1 day for admission/discharge dates, date of birth, sex, and hospital), then on 4/5 linked identifiers. Stroke severity based on National Institutes of Health Stroke Scale score was extracted from GWTG-stroke. Logistic regression models were used to calculate odds ratios (OR) of having a mild severity stroke (National Institutes of Health Stroke Scale score ≤5) by sex in ages 18 to 45 and 46 to 55 years.
Results:
Colorado All Payer's Claims Database captured 3029 stroke cases; 2732 from hospitals that reported to GWTG-Stroke; 1597 (58.7%) linked at least 4/5 identifiers; 1311 with National Institutes of Health Stroke Scale score (50.2% women, 80% ischemic). Women were younger (mean age 45.4 years, men 46.9 years, P=0.001), had lower blood pressure (median 143/85, men 150/91, P<0.001), and lower proportion without nontraditional risk factors (16.7%, men 29.0%, P<0.001). No sex differences in stroke severity were observed for all strokes (OR 18-45, 1.10 [95% CI, 0.74-1.61]; OR, 46-55, 0.80 [95% CI, 0.59-1.09]). Women aged 18 to 45 years experienced more mild severity hemorrhagic strokes (OR, 2.94 [95% CI, 1.18-7.69], P=0.02) but not in 46-55 (OR, 1.02 [95% CI, 0.5-2.08]). There was no difference in ischemic stroke severity by sex in either age group.
Conclusions:
Young women with index strokes did not present with more milder severity strokes compared with men.
