SEX-SPECIFIC DIFFERENCES IN STROKE EPIDEMIOLOGY IN LUSAKA, ZAMBIA

Abstract

<h3>Introduction</h3> Sex-specific characteristics of stroke and access to post-stroke care data remain limited in sub-Saharan Africa. <h3>Objective</h3> Evaluate sex-specific stroke risk factors and characteristics of stroke care among adults with stroke in Zambia. <h3>Methods</h3> We retrospectively collected demographic, clinical, laboratory and imaging results, and in-hospital mortality for consecutive adults admitted with stroke to University Teaching Hospital in Lusaka, Zambia between October 2018 – April 2019. Strokes were classified as ischemic or hemorrhagic based on CT appearance, and as unknown if neuroimaging was unavailable. Descriptive statistics were compared by sex among adults with stroke using t-tests for continuous variables and chi-squared analysis for categorical variables. <h3>Results</h3> Women constituted 62% (n=200) of the cohort, were older (61±19 years vs 57±16 years, p=0.06) and had lower rates of hemorrhagic stroke (22% vs 37%, p=0.001). Hypertension (84% vs 74%, p=0.04) and diabetes (19% vs 13%, p=0.04) were more frequent in women. Several delays exist between stroke onset and care for women, including lack of CT imaging during hospitalization (82% vs 94% men, p=0.002), and, among those with neuroimaging, a trend towards longer delays in obtaining imaging with 69% of women having ≥1 day delay between admission and CT imaging compared to 53% of men (p=0.10). <h3>Discussion</h3> Females with stroke have fewer hemorrhagic strokes and higher prevalence of stroke risk factors. Women experience delays in acquiring post-stroke care, including in obtaining CT imaging, compared to men. Our data necessitates further study of social and socioeconomic factors that may result in women having reduced access to quality acute stroke and preventative care.