Stroke gender differences not due to treatment bias

Australian authors of a study on gender differences in stroke outcome have found little evidence of gender bias in stroke management. The study, led by Dr Seana Gall from the Menzies Research Institute, University of Tasmania, found that the gender differences in stroke outcome seen in their study of almost 1,500 stroke patients were mostly explained by women’s older age, greater co-morbidity and stroke severity. “…We found no sex differences in relation to the new prescription of well-established therapies such as antihypertensives… at discharge,” they said. Writing in Neurology the authors noted that previous studies had differed in findings related to sex differences in stroke unit admissions with some reporting no differences and others showing gender differences in thrombolysis, investigation of lipid levels and in-hospital diagnostic procedures. The North East Melbourne Stroke Incidence Study examined gender differences in diagnosis and acute treatment and management of stroke in a large cohort of 1,316 stroke patients (56% were women). Of these, 92% (n= 1,208) were admitted to hospital, with women less often admitted than men (p<0.01). The study found women were older (mean age 76), had more severe strokes, were less often on lipid-lowering therapy (34% vs 49% p=0.006) and more often on antihypertensives (58% vs 50% p=0.018) pre-stroke. Women were also significantly more likely to have hypertension, dementia, reside in an institution and to present with a subarachnoid haemorrhage, or undetermined stroke type than men, who tend to have higher incidence of ischaemic stroke. Women presenting with ischaemic stroke were less likely to undergo echocardiography or carotid investigations (33% vs 44%) due to greater age and stroke severity, the study authors said. Women were also less likely to have heavy alcohol intake, diabetes, myocardial infarction, or to smoke. They also presented more often with incontinence, loss of consciousness, visual deficits and dysphasia as opposed to dysarthria, ataxia, or parasthesia, and they had greater 28-day mortality than men. “Given the importance of age as an explanatory factor in many analyses, there is a need to justify the reason for the age bias in the management and investigation of stroke patients,” the authors concluded. Neurology 2010; 74:1-1...