Introduction: Women have been reported to receive evidence-based care less often than men, but it is uncertain whether this contributes to sex differences in outcomes after stroke. We examined this using data obtained from the Australian Stroke Clinical Registry (AuSCR).
Methods: We included first-ever strokes admitted to 40 hospitals participating in the AuSCR during 2010-2013. Mortality one year after stroke was obtained from linkage to the National Death Index. Multilevel Poisson modelling, accounting for hospital, was used to estimate the mortality rate ratio (MRR) for women compared to men. Multivariable models were adjusted for sociodemographics, stroke type, severity (ability to walk on admission) and the provision of evidence-based therapies while in hospital (stroke unit care, thrombolysis, secondary prevention medications, dysphagia screening and mobilization).
Results: Data were available for 9,549 strokes (47% women, 80% ischaemic stroke). Women, compared to men, were older (mean [SD] 75.0 [15.0] vs 70.3 [13.9], p<0.001) and less able to walk on admission (32% vs 41%, p<0.001). Overall, there were no sex differences in access to evidence-based therapies in hospital, although it appeared that slightly fewer women were admitted to a stroke unit (79% vs 81%, p=0.001). In a subset of patients from Queensland (n=3,013), women were less often mobilised (74% vs 79%, p=0.04) or administered aspirin within 48 hours of stroke onset (66% vs 74%, p<0.001). Mortality was greater in women than men at one year (MRRcrude 1.42 [95% CI 1.31, 1.55]). This association was attenuated when adjusting for age and severity of stroke (MRRadjusted 1.00 [95% CI 0.92, 1.09] but not by any of the evidence-based therapies.
Conclusion: Greater mortality in women was associated with differences in age and stroke severity and not differences in access to care. Improvements in care for the elderly and the management of modifiable factors of stroke severity should reduce sex differences in outcomes.