Abstract P259: The Association Between Sex, Gender and Health Status of Stroke Survivors in the Canadian Population

Abstract

Background: Stroke is one of the most common cerebrovascular diseases causing permanent disability, and decreased quality of life (QoL). Both sex and gender have been reported to be associated with health outcomes. Gender, unlike biological sex, encompasses the psycho-socio-cultural roles, behaviors and identities of men, women, and gender-diverse people. Hypothesis: To examine the association between sociocultural gender, biological sex and health status among stroke survivors in the Canadian population. Methods: Data from cycles 2013-2014 and 2015-16 (n=237,121) of the Canadian Community Health Survey (CCHS) were analyzed. The primary endpoint of the study was Health Utility Index (HUI), a measure of health status and QoL. This index measures a range of health domains (i.e. vision, hearing, speech, ambulation, dexterity, emotion, cognition, and pain) and ranges between -0.36 (severe health state) to 1 (perfect health state). A gender score was computed based on the Genesis-Praxy method, using a principal component analysis-derived propensity score method. The final gender scores ranging from 0 to 1 (higher score identifying characteristics traditionally ascribed to women) included household size, perceived life stress, education, sense of belonging to community, marital status, and income. All statistical analyses were performed using R (V.4.0.2) with survey design. Results: Amongst 3,773 (1.1%) stroke survivors in two cycles, 47.8% were female and a majority were older than 50 years (85.3%). Overall, 76.4% of the stroke survivors had moderate to severe HUI (<=0.88), however, this rate was higher in females (82.5% vs 70.2%, P<0.001). Median gender score was 0.49 [0.46-0.55]. Higher gender scores (OR=12.5, 95%CI=1.4-116.2, P=0.02) and female sex (OR=1.8, 95%CI=1.2-2.8, P=0.002) were independently associated with moderately to severely diminished health status (HUI) in a model adjusted for age, and comorbidities (i.e. hypertension, diabetes, heart disease, and history of cancer). Conclusion: Characteristics traditionally ascribed to women’s gender and female sex were associated with poorer health status in stroke survivors. Gender-related factors must be targeted for improving the health status of patients suffering from stroke.