Background: Several studies have shown that women with ischemic stroke receive fewer proven therapies for secondary prevention. A small study found that women receive early DNR orders after intracerebral hemorrhage (ICH) more often than men (Stroke 2013; 44: 3229) but national data regarding sex differences in ICH are lacking.
Objective: To compare comorbidities and use of surgical treatments and palliative care between men and women with ICH. We tested the hypothesis that women receive less aggressive care after ICH.
Methods: ERICH is a multi-center study of ICH risk factors and outcomes. We compared clinical variables, treatments (e.g., hematoma evacuation), and use of DNR orders in men compared with women. Chi square tests(categorical items) and t-tests (continuous items) were performed. Multivariable analyses assessed the likelihood of ICH surgery and/or palliative care after adjustment for variables that were significant (p<.05) in univariate analyses.
Results: 2964 patients (1220 women) were analyzed. Mean age was higher in women (65.0 vs. 59.9, p<.0001). There was no sex difference in hypertension frequency but women had a higher proportion of previous stroke (24.1% vs. 19.3%, p=.002), dementia (6.1% vs. 3.4%, p=.0007), and anticoagulant use (12.8% vs. 10.1%, p=.02). Men had a higher proportion of cocaine use (10.1% vs. 4.7%, p<.0001) and higher initial SBP (187.5 mm vs. 183.5 mm, p=.007). A higher proportion of women reported living alone (23.1% vs. 18.0%, p=.0005) and a higher proportion of women had a lobar ICH (36.9% vs. 27.4%, p<.0001). After adjustment for age, dementia, prior stroke, anticoagulant use, and ICH location, there was no difference in surgical treatment between men and women (OR=0.92, 95%CI=0.67-1.26, p=.59). Although a higher proportion of women were made DNR/comfort care (19.4% vs. 15.3%, p=.003), this finding was no longer significant after adjustment for ICH score, prior stroke, and dementia (OR for male sex=.96, 95%CI=0.77-1.22, p=.76).
Conclusions: Despite sex differences in several categories, no observable sex differences were found in use of surgical therapies or use of DNR/comfort care in an American population. Future work should focus on whether sex differences exist following ICH in patient-centered outcomes.