Sex Differences in Long-Term Functional Decline after Ischemic Stroke: A Longitudinal Observational Study from the Fukuoka Stroke Registry

Clinical Research in Stroke

Irie F.a,b· Matsuo R.a,b· Nakamura K.Wakisaka Y.Ago T.b· Kitazono T.b,c· Kamouchi M.a,c· on behalf of the Fukuoka Stroke Registry Investigators

Author affiliations

aDepartment of Health Care Administration and Management, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
bDepartment of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
cCenter for Cohort Studies, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan

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Article / Publication Details

First-Page Preview

Abstract of Clinical Research in Stroke

Received: June 15, 2022
Accepted: August 30, 2022
Published online: February 08, 2023

Number of Print Pages: 8
Number of Figures: 2
Number of Tables: 2

ISSN: 1015-9770 (Print)
eISSN: 1421-9786 (Online)

For additional information: https://www.karger.com/CED

Abstract

Introduction: Data on sex differences in poststroke functional status for a period longer than 1 year based on large cohorts are sparse. This study aimed to determine whether there are sex differences in long-term functional decline after ischemic stroke. Methods: We tracked functional status for 5 years among 3-month survivors of acute ischemic stroke and compared outcomes between women and men using a large-scale hospital-based stroke registry in Fukuoka, Japan. Functional status was assessed using the modified Rankin Scale (mRS). Functional dependency was defined as an mRS score of 3, 4, or 5. Logistic regression analysis was used to estimate odds ratios (ORs) and 95% confidence intervals of outcomes after adjusting for possible confounders. Results: A total of 8,446 patients (71.9 ± 12.5 years, 3,377 (40.0%) female patients) were enrolled in this study. Female sex was associated with a higher risk of functional dependency at 5 years poststroke even when adjusting for age, 3-month mRS score, and other confounding factors (multivariable-adjusted OR vs. men, 1.56 [95% confidence interval, 1.26–1.93]). This significant association of female sex with higher dependency at 5 years was also found among patients who were independent at 3 months poststroke. Subgroup analysis showed that increased risk of functional dependency in female patients was more marked in patients aged ≥75 years than in those aged <75 years (p for heterogeneity = 0.02). Conversely, female sex was associated with a lower risk of death. No sex difference was observed in stroke recurrence during 5 years poststroke. Discussion/Conclusion: This longitudinal observational study suggests that female sex was independently associated with an increased risk of functional decline in the chronic phase of stroke, especially in older patients. There was no sex difference in 5-year stroke recurrence, and thus, other factors might be involved in more significant deterioration of functional status in female survivors of ischemic stroke. Further studies are needed to elucidate underlying causes of sex differences in long-term functional decline after stroke.

© 2023 S. Karger AG, Basel

References Niewada M, Kobayashi A, Sandercock PA, Kaminski B, Czlonkowska A, the International Stroke Trial Collaborative Group. Influence of gender on baseline features and clinical outcomes among 17,370 patients with confirmed ischaemic stroke in the International Stroke Trial. Neuroepidemiology. 2005 April;24(3):123–8. Reeves MJ, Bushnell CD, Howard G, Gargano JW, Duncan PW, Lynch G, et al. Sex differences in stroke: epidemiology, clinical presentation, medical care, and outcomes. The Lancet Neurol. 2008 Oct;7(10):915–26. Gall SL, Tran PL, Martin K, Blizzard L, Srikanth V. Sex differences in long-term outcomes after stroke: functional outcomes, handicap, and quality of life. Stroke. 2012 Jul;43(7):1982–7. Phan HT, Blizzard CL, Reeves MJ, Thrift AG, Cadilhac DA, Sturm J, et al. Factors contributing to sex differences in functional outcomes and participation after stroke. Neurology. 2018 May;90(22):e1945–e1953. Lai SM, Duncan PW, Dew P, Keighley J. Sex differences in stroke recovery. Prev Chronic Dis. 2005 Jul;2(3):A13. Renoux C, Coulombe J, Li L, Ganesh A, Silver L, Rothwell PM, et al. Confounding by pre-morbid functional status in studies of apparent sex differences in severity and outcome of stroke. Stroke. 2017 Oct;48(10):2731–8. Di Carlo A, Lamassa M, Baldereschi M, Pracucci G, Basile AM, Wolfe CDA, et al. Sex differences in the clinical presentation, resource use, and 3-month outcome of acute stroke in Europe: data from a multicenter multinational hospital-based registry. Stroke. 2003 May;34(5):1114–9. Wolfe CDA, Tilling K, Rudd A, Giroud M, Inzitari D. Variations in care and outcome in the first year after stroke: a Western and Central European perspective. J Neurol Neurosurg Psychiatry. 2004 Dec;75(12):1702–6. Irie F, Kamouchi M, Hata J, Matsuo R, Wakisaka Y, Kuroda J, et al. Sex differences in short-term outcomes after acute ischemic stroke: the Fukuoka stroke registry. Stroke. 2015 Feb;46(2):471–6. Lisabeth LD, Reeves MJ, Baek J, Skolarus LE, Brown DL, Zahuranec DB, et al. Factors influencing sex differences in poststroke functional outcome. Stroke. 2015 Mar;46(3):860–3. Dhamoon MS, Moon YP, Paik MC, Boden-Albala B, Rundek T, Sacco RL, et al. Long-term functional recovery after first ischemic stroke: the Northern Manhattan Study. Stroke. 2009 Aug;40(8):2805–11. Feigin VL, Barker-Collo S, Parag V, Senior H, Lawes CMM, Ratnasabapathy Y, et al. Auckland Stroke Outcomes Study. Part 1: Gender, stroke types, ethnicity, and functional outcomes 5 years poststroke. Neurology. 2010 Nov;75(18):1597–607. Ganesh A, Luengo-Fernandez R, Wharton RM, Gutnikov SA, Silver LE, Mehta Z, et al. Time course of evolution of disability and cause-specific mortality after ischemic stroke: implications for trial design. J Am Heart Assoc. 2017 Jun;6(6):e005788. Sennfält S, Norrving B, Petersson J, Ullberg T. Long-term survival and function after stroke. Stroke. 2019;50(1):53–61. Kamouchi M, Matsuki T, Hata J, Kuwashiro T, Ago T, Sambongi Y, et al. Prestroke glycemic control is associated with the functional outcome in acute ischemic stroke: the Fukuoka Stroke Registry. Stroke. 2011 Oct;42(10):2788–94. Kumai Y, Kamouchi M, Hata J, Ago T, Kitayama J, Nakane H, et al. Proteinuria and clinical outcomes after ischemic stroke. Neurology. 2012 Jun;78(24):1909–15. Kolominsky-Rabas PL, Weber M, Gefeller O, Neundoerfer B, Heuschmann PU. Epidemiology of ischemic stroke subtypes according to TOAST criteria: incidence, recurrence, and long-term survival in ischemic stroke subtypes: a population-based study. Stroke. 2001 Dec;32(12):2735–40. Gordon EH, Peel NM, Samanta M, Theou O, Howlett SE, Hubbard RE. Sex differences in frailty: a systematic review and meta-analysis. Exp Gerontol. 2017 Mar;89:30–40. Paolucci S, Bragoni M, Coiro P, De Angelis D, Fusco FR, Morelli D, et al. Is sex a prognostic factor in stroke rehabilitation? A matched comparison. Stroke. 2006 Dec;37(12):2989–94. Olsen TS, Dehlendorff C, Andersen KK. Sex-related time-dependent variations in post-stroke survival: evidence of a female stroke survival advantage. Neuroepidemiology. 2007 Dec;29(3–4):218–25. Vyas MV, Silver FL, Austin PC, Yu AYX, Pequeno P, Fang J, et al. Stroke incidence by sex across the lifespan. Stroke. 2021 Jan;52(2):447–51. Quinn TJ, Dawson J, Walters MR, Lees KR. Reliability of the modified Rankin Scale: a sytematic review. Stroke. 2009 Oct;40(10):3393–5. Shinohara Y, Minematsu K, Amano T, Ohashi Y. Modified Rankin scale with expanded guidance scheme and interview questionnaire: interrater agreement and reproducibility of assessment. Cerebrovasc Dis. 2006 Jan;21(4):271–8. Article / Publication Details

First-Page Preview

Abstract of Clinical Research in Stroke

Received: June 15, 2022
Accepted: August 30, 2022
Published online: February 08, 2023

Number of Print Pages: 8
Number of Figures: 2
Number of Tables: 2

ISSN: 1015-9770 (Print)
eISSN: 1421-9786 (Online)

For additional information: https://www.karger.com/CED

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