Foerch Christian, Misselwitz Bjoern, Humpich Marek, Steinmetz Helmuth, Neumann-Haefelin Tobias, Sitzer Matthias
Department of Neurology, Johann Wolfgang Goethe University, Frankfurt am Main, Germany.
Stroke. 2007 Jul;38(7):2123-6. doi: 10.1161/STROKEAHA.106.478495. Epub 2007 May 24.
Sex differences in the management of acute coronary symptoms are well documented. We sought to determine whether sex disparities exist in acute stroke management, particularly with regard to early hospital admission and thrombolytic therapy.
We analyzed a prospective, countywide, hospital-based stroke registry. Between 1999 and 2005, all cases with a final diagnosis of cerebral infarction (ICD-10 I63) or intracerebral hemorrhage (ICD-10 I61) were selected. Datasets with missing values for sex and time to admission, as well as datasets of patients transferred between hospitals in the acute phase, were excluded. Main outcome measures were the probability of being admitted within the first 3 hours of stroke onset and being treated with thrombolytic agents for both women and men, after adjustment for age, prestroke disability, severity of clinical symptoms, vascular risk factors, and final diagnosis.
Fifty-three thousand four hundred fourteen patients were included (49.3% female; mean+/-SD age, 72.1+/-12.5 years). Women had a 10% lower chance of being admitted within the first 3 hours than men (odds ratio=0.902, 95% CI=0.860 to 0.945, P<0.001). This chance further decreased in elderly women. Similarly, the chance of a female stroke patient being treated with thrombolysis was 13% lower than that of a male patient (odds ratio=0.867, 95% CI=0.782 to 0.960, P=0.006). For patients admitted within the 3-hour time window, the chance of being treated with thrombolysis was similar for women and men (odds ratio=0.915, 95% CI=0.809 to 1.035, P=0.156).
We identified sex disparities in acute stroke management in terms of early hospital admission and thrombolytic treatment. This is best explained by the sociodemographic fact that "surviving spouses" are more likely to be women than men. Attempts to overcome disadvantages in their access to acute stroke care should focus on increased social support.
急性冠脉症状管理中的性别差异已有充分记录。我们试图确定急性卒中管理中是否存在性别差异，特别是在早期入院和溶栓治疗方面。
我们分析了一个基于全县医院的前瞻性卒中登记系统。在1999年至2005年期间，选取所有最终诊断为脑梗死（国际疾病分类第十版I63）或脑出血（国际疾病分类第十版I61）的病例。排除性别和入院时间缺失值的数据集，以及急性期在医院间转诊患者的数据集。主要结局指标是在调整年龄、卒中前残疾情况、临床症状严重程度、血管危险因素和最终诊断后，男女患者在卒中发作后3小时内入院的概率以及接受溶栓治疗的概率。
共纳入53414例患者（女性占49.3%；平均年龄±标准差为72.1±12.5岁）。女性在卒中发作后3小时内入院的几率比男性低10%（优势比=0.902，95%可信区间=0.860至0.945，P<0.001）。老年女性的这一几率进一步降低。同样，女性卒中患者接受溶栓治疗的几率比男性患者低13%（优势比=0.867，95%可信区间=0.782至0.960，P=0.006）。对于在3小时时间窗内入院的患者，男女接受溶栓治疗的几率相似（优势比=0.915，95%可信区间=0.809至1.035，P=0.156）。
我们发现急性卒中管理在早期入院和溶栓治疗方面存在性别差异。这最好用社会人口学事实来解释，即“未亡配偶”中女性比男性更常见。克服她们在获得急性卒中治疗方面劣势的努力应侧重于增加社会支持。
