Sex differences in quality of life after stroke were explained by patient factors, not clinical care: evidence from the Australian Stroke Clinical Registry
H. T. Phan
Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
Department of Public Health Management, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
Search for more papers by this authorS. L. Gall
Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
Search for more papers by this authorC. L. Blizzard
Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
Search for more papers by this authorN. A. Lannin
Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
Alfred Health, Melbourne, Victoria, Australia
Search for more papers by this authorA. G. Thrift
Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
Search for more papers by this authorC. S. Anderson
Faculty of Medicine, The George Institute for Global Health, The University of New South Wales, Sydney, New South Wales, Australia
Search for more papers by this authorJ. Kim
Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
Search for more papers by this authorR. S. Grimley
Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
School of Medicine, Griffith University, Birtinya, Queensland, Australia
Search for more papers by this authorH. C. Castley
Neurology Department, Royal Hobart Hospital, Hobart, Tasmania, Australia
Search for more papers by this authorM. F. Kilkenny
Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
Stroke Theme, The Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia
Search for more papers by this authorCorresponding Author
D. A. Cadilhac
Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
Stroke Theme, The Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia
Correspondence: D. A. Cadilhac, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Level 3 Hudson Institute Building, 27-31 Wright Street, Clayton Victoria 3168, Australia (tel.: +61 3 8572 2657; fax: +61 3 9902 4245; e-mail: [email protected]).
Search for more papers by this authorthe AuSCR Consortium, Stroke123 Investigators
Search for more papers by this authorH. T. Phan
Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
Department of Public Health Management, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
Search for more papers by this authorS. L. Gall
Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
Search for more papers by this authorC. L. Blizzard
Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
Search for more papers by this authorN. A. Lannin
Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
Alfred Health, Melbourne, Victoria, Australia
Search for more papers by this authorA. G. Thrift
Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
Search for more papers by this authorC. S. Anderson
Faculty of Medicine, The George Institute for Global Health, The University of New South Wales, Sydney, New South Wales, Australia
Search for more papers by this authorJ. Kim
Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
Search for more papers by this authorR. S. Grimley
Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
School of Medicine, Griffith University, Birtinya, Queensland, Australia
Search for more papers by this authorH. C. Castley
Neurology Department, Royal Hobart Hospital, Hobart, Tasmania, Australia
Search for more papers by this authorM. F. Kilkenny
Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
Stroke Theme, The Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia
Search for more papers by this authorCorresponding Author
D. A. Cadilhac
Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
Stroke Theme, The Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia
Correspondence: D. A. Cadilhac, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Level 3 Hudson Institute Building, 27-31 Wright Street, Clayton Victoria 3168, Australia (tel.: +61 3 8572 2657; fax: +61 3 9902 4245; e-mail: [email protected]).
Search for more papers by this authorthe AuSCR Consortium, Stroke123 Investigators
Search for more papers by this authorSee editorial by E. C. Sandset and M. T. Ferretti on page 365
Abstract
Background and purpose
Women may receive stroke care less often than men. We examined the contribution of clinical care on sex differences and health-related quality of life (HRQoL) after stroke.
Methods
We included first-ever strokes registered in the Australian Stroke Clinical Registry (2010–2014) with HRQoL assessed between 90 and 180 days after onset (EQ-5D-3L instrument) that were linked to hospital administrative data (up to 2013). Study factors included sociodemographics, comorbidities, walking ability on admission (stroke severity proxy) and clinical care (e.g. stroke unit care). Responses to the EQ-5D-3L were transformed into a total utility value (−0.516 ‘worse than death’ to 1 ‘best’ health). Quantile regression models, adjusted for confounding factors, were used to determine median differences (MD) in utility scores by sex.
Results
Approximately 60% (6852/11 418) of stroke survivors had an EQ-5D-3L assessment (median 139 days; 44% female). Compared with men, women were older (median age 77.1 years vs. men 71.2 years) and fewer could walk on admission (37.9% vs. men 46.1%, P < 0.001). Women had lower utility values than men, and the difference was explained by age and stroke severity, but not clinical care [MDadjusted = −0.039, 95% confidence interval: −0.056, −0.021]. Poorer HRQoL was observed in younger men (aged <65 years), particularly those with more comorbidities, and in older women (aged ≥75 years).
Conclusions
Stroke severity and comorbidities contribute to the poorer HRQoL in young men and older women. Further studies are needed to understand age–sex interaction to better inform treatments for different subgroups and ensure evidence-based treatments to reduce the severity of stroke are prioritized.
Disclosure of conflicts of interest
D.A.C., N.A.L., R.S.G., M.F.K. and C.S.A. are members of the management committee for AuSCR. D.A.C. reports educational grants from Boehringer Ingelheim, Shire, Ipsen, Amgen and Medtronic paid to her institution. C.S.A. has research grants from Takeda paid to his institution and speaker fees from Takeda unrelated to this work. A.G.T. declares being on the AuSCR Steering Committee and board of the Stroke Foundation. The other authors do not have any disclosures. No competing financial interests exist.
Open Research
Data availability statement
This study is based on the secondary analysis of data as part of a data linkage study. Qualified investigators can request access to patient-level data, analytic methods and study materials after ethics clearance and approval by all authors and the data custodians of the primary sources of the datasets.
Supporting Information
| Filename | Description |
|---|---|
| ene14531-sup-0001-Supinfo.pdfPDF document, 843.3 KB |
Table S1. Baseline characteristics of stroke survivors providing EQ5D response and those without a response at 3 to 6 months after stroke. Table S2. Characteristic of AuSCR registrants for first–ever stroke during 2010 to 2014 providing EQ5D responses at 3 months after stroke (n = 39 hospitals). Table S3. Relative risk (RR) of having any problem in each dimension of EQ5D for women compared to men, using log-binomial regression. Table S4. Sensitivity analyses accounting for missing EQ5D data. Difference in EQ5D scores between women and men survivors at 3 to 6 months after stroke according to age group and stroke severity. Figure S1. Predicted probability of issue with usual activity by Charlson Comorbidity Index and age among men (top; Pinteraction = 0.688) and women (bottom; Pinteraction = 0.969). Figure S2. Predicted probability of issue with self-care by Charlson Comorbidity Index and age among men (top; Pinteraction = 0.695) and women (bottom; Pinteraction = 0.128). Figure S3. Predicted probability of issue with anxiety or depression by Charlson Comorbidilty Index and age among men (top; Pinteraction = 0.725) and women (bottom; Pinteraction = 0.828). |
Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
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