Abstract WP285: Stroke Recurrence and Poststroke Mortality: Sex Differences and Contributors in a Population-Based Study

Abstract

Few population-based studies have assessed whether stroke recurrence differs by sex. Additionally, contributors, particularly social factors, to sex differences in recurrence and poststroke mortality are unclear. Methods: First-ever ischemic stroke cases (2008-2019) identified from the population-based Brain Attack Surveillance in Corpus Christi Project were included. Recurrence and all-cause mortality were ascertained through 2020. Sex differences in outcomes with and without adjustment for 21 potential contributors (Figure) were examined by Cox proportional hazard models. Contributions of each factor to sex differences were assessed by change in the β estimate for sex before and after adjustment. Final models including all identified contributors (≥ 10% contribution) were conducted. Results: Of 2,326 participants (mean age 68 years; 48% women; 57% Mexican American), 274 had a recurrence and 965 died (median follow-up 5.4 and 3.7 years, respectively). No significant sex difference in recurrence was noted before (HR 0.89, 95% CI 0.70-1.13) or after adjustment in the final model (HR 0.86, 95% CI 0.66-1.13). While women had a higher crude mortality rate than men (HR 1.23, 95% CI 1.08-1.39), after adjusting for identified contributors (Figure), women had lower mortality (HR 0.79, 95% CI 0.67-0.92). Age and marital status were the two most important contributors to the sex difference. Other contributors included social support, physician access, insurance, stroke severity, coronary artery disease, prestroke disability, and alcohol consumption (Figure). Conclusion: Crudely, women had a nonsignificantly lower recurrence rate but higher poststroke mortality rate than men. After adjustment, women had a similar recurrence rate but lower mortality rate. Findings suggest that in addition to clinical factors, social factors including physician access, private insurance, having a partner, and higher social support, impact sex differences in stroke outcomes.