Introduction: Studies have suggested that women may receive lower quality of care (QOC) than men, although population-based studies are lacking. We investigated sex disparities in QOC in the Brain Attack Surveillance in Corpus Christi Project.
Methods: All ischemic stroke patients admitted to one of six Nueces County community hospitals between Feb 2009 and Jun 2012 were prospectively identified. Data regarding compliance with seven performance measures (PMs) were extracted from the medical records. A composite score of QOC representing the number of achieved PMs over all patient-appropriate PMs was calculated. Multivariable models with generalized estimating equations assessed the association between sex and the composite score and between sex and individual PMs. Models were adjusted for hospital clustering, age, and ethnicity, while the model assessing composite score was also adjusted for insurance status, education, pre-stroke functional status (Rankin 0-2), initial NIH stroke scale score, and comorbidity index.
Results: Compared to men, women were older (median age 72 vs 65), less likely to have a pre-stroke Rankin 0-2 (69% vs 83%), and less likely to identify as married/living together (38% vs 61%). Results for the association of sex with individual PMs are shown below. Women were less likely to receive DVT prophylaxis at 48 hours, an antithrombotic at 48 hours, and to be discharged on an antithrombotic. Women were less likely to be discharged on a cholesterol medication, although this finding was of borderline significance. Women had a lower composite score (mean difference -0.030, 95% CI -0.057 to -0.003).
Conclusions: In this population-based study, women had a lower overall stroke QOC, although absolute differences in most individual PMs were small. Further investigation into the factors contributing to the gender disparity in guideline-concordant stroke therapy should be pursued.