‘Little evidence’ of gender bias in stroke management
MedWire News: Researchers found little evidence of gender disparity in stroke management that could not be explained by clinical features related to prognosis.
Seana Gall (University of Tasmania, Hobart, Australia) and colleagues note that age was an important explanatory factor for gender disparity in their analyses, and call for more investigation in a potential age bias in the management and investigation of stroke patients.
For their population-based, Gall et al analyzed data on 1316 patients collected from May 1996 to April 1999 as part of the North East Melbourne Stroke Incidence Study (NEMESIS).
Stroke symptoms, prestroke medical history, in-hospital investigations, admission and discharge medications, initial stroke severity, and 28-day mortality were recorded. Multivariable regression analysis was used to estimate gender differences in treatment, investigations, and 28-day mortality.
Women had a mean age of 76 years, which was significantly older than the mean age of 72 years for men. They had more severe strokes, with a median National Institutes of Health Stroke Scale score of 6 versus 5 for men. Women were also more likely to experience loss of consciousness (31% vs 23%) and incontinence (22% vs 11%) than men.
Women were less often on lipid-lowering therapy on admission (34% vs 49%), which seemed to be due to a lesser history of cardiovascular disease. Echocardiography (33% vs 44%) and carotid investigations (61% vs 72%) were also less frequently performed in women than men due to greater age and stroke severity.
As reported in the journal Neurology, women had greater 28-day mortality (32% vs 21%) and stroke severity (44% vs 36%) than men, but adjustment for age, comorbidities, and stroke severity completely attenuated these associations.
In accompanying editorial, Mathew Reeves (Michigan State University, East Lansing, USA) and Lynda Lisabeth (University of Michigan, Ann Arbor,, USA) commented: “These data should not suggest that we end our investigations into sex disparities in stroke, but rather that we try to better understand how and why age and other factors influence stroke care.”
MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2010
By James Taylor