Abstract WP405: Sex Differences in Post-Stroke Functional Outcomes

Abstract

Background: Studies consistently show that women have less favorable functional outcomes after stroke than men but the causes are uncertain. Our objective was to assess sex differences in functional outcomes measured 90-days post event in a population-based stroke study and to identify which pre-stroke factors and clinical stroke characteristics explain sex differences. Methods: Ischemic stroke patients (n=398) were identified from the Brain Attack Surveillance in Corpus Christi (BASIC) Project (2008-2011). Data were ascertained from in-person patient or proxy interviews (baseline and 90 days post-stroke) and medical records. Functional outcome at 90 days was measured as total ADL/IADL score (range 22-88, higher scores indicate poorer function). Tobit regression was used to estimate sex differences in outcome. To identify clinically important confounding factors, individual variables were added to age-adjusted models to determine if the sex difference changed by ≥ 5%. A final multivariable model was run including sex, age, ethnicity, and identified confounders. Results: Median age was 69 (IQR: 57, 79) and 52% were women. In crude and age-adjusted models women scored 11.2 points (p<0.001) and 8.7 points (p<0.001) higher on the ADL/IADL score respectively. After accounting for age, stroke severity, pre-stroke functional and cognitive status, pre-stroke comorbidity index, nursing home residence, history of stroke/TIA, BMI and marital status were all clinically important confounders of the sex difference. In the final multivariable model, a sex difference in functional outcome remained, with women scoring 6.2 points higher on the ADL/IADL score than men (p<0.01). Conclusions: Women had poorer functional outcomes post stroke even after accounting for differences in age, pre-stroke confounding factors and stroke severity. Age, pre-stroke factors and stroke severity explained about half of the total observed sex difference. Further research is needed to identify the reasons why women have poorer outcomes in order to design interventions aimed at reducing stroke disability in women.