Sex Disparities in Ischemic Stroke Care

Author:

Asdaghi Negar1,Romano Jose G.1,Wang Kefeng1,Ciliberti-Vargas Maria A.1,Koch Sebastian1,Gardener Hannah1,Dong Chuanhui1,Rose David Z.1,Waddy Salina P.1,Robichaux Mary1,Garcia Enid J.1,Gonzalez-Sanchez Juan A.1,Burgin W. Scott1,Sacco Ralph L.1,Rundek Tatjana1

Affiliation:

1. From the Department of Neurology, University of Miami Miller School of Medicine, FL (N.A., J.G.R., K.W., M.A.C-.V., S.K., H.G., C.D., R.L.S., T.R.); Department of Neurology, University of South Florida School of Medicine, Tampa (D.Z.R., W.S.B.); National Institute of Neurological Disorders and Stroke, Bethesda, MD (S.P.W.); The American Heart Association, Greater Southeast Affiliate, Marietta, GA (M.R.); and Endowed Health Services Research Center (E.J.G.) and Department of Emergency Medicine (J.A.G...

Abstract

Background and Purpose— Sex-specific disparities in stroke care including thrombolytic therapy and early hospital admission are reported. In a large registry of Florida and Puerto Rico hospitals participating in the Get With The Guidelines—Stroke program, we sought to determine sex-specific differences in ischemic stroke performance metrics and overall thrombolytic treatment. Methods— Around 51 317 (49% women) patients were included from 73 sites from 2010 to 2014. Multivariable logistic regression with generalized estimating equations evaluated sex-specific differences in the prespecified Get With The Guidelines—Stroke metrics for defect-free care in ischemic stroke, adjusting for age, race-ethnicity, insurance status, hospital characteristics, individual risk factors, and the presenting stroke severity. Results— As compared with men, women were older (73±15 versus 69±14 years; P <0.0001), more hypertensive (67% versus 63%, P <0.0001), and had more atrial fibrillation (19% versus 16%; P <0.0001). Defect-free care was slightly lower in women than in men (odds ratio, 0.96; 95% confidence interval, 0.93–1.00). Temporal trends in defect-free care improved substantially and similarly for men and women, with a 29% absolute improvement in women ( P <0.0001) and 28% in men ( P <0.0001), with P value of 0.13 for time-by-sex interaction. Women were less likely to receive thrombolysis (odds ratio, 0.92; 95% confidence interval, 0.86–0.99; P =0.02) and less likely to have a door-to-needle time <1 hour (odds ratio, 0.83; 95% confidence interval, 0.71–0.97; P =0.02) as compared with men. Conclusions— Women received comparable stroke care to men in this registry as measured by prespecified Get With The Guidelines metrics. However, women less likely received thrombolysis and had door-to-needle time <1 hour, an observation that calls for the implementation of interventions to reduce sex disparity in these measures.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Advanced and Specialized Nursing,Cardiology and Cardiovascular Medicine,Neurology (clinical)

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