Smith Don B, Murphy Paul, Santos Patricia, Phillips Merrilee, Wilde Marsha
Colorado Stroke Alliance and Colorado Neurological Institute, Engelwood, Colorado, USA.
Stroke. 2009 Apr;40(4):1078-81. doi: 10.1161/STROKEAHA.108.541730. Epub 2009 Feb 10.
Gender differences in stroke are matters of increasing interest. The American Stroke Association's patient management tool, Get with the Guidelines-Stroke (GGS) is widely used to increase adherence to quality indicators in stroke care, but it also provides an opportunity to analyze gender differences in the acute stroke setting.
We used a state-wide database, based on GGS, to explore gender differences in stroke in Colorado. We analyze demographics, risk factors, lifestyles, treatments, and responses to treatment.
Of 126 data elements examined, statistically significant gender differences were noted for 47 (37%). As compared to men, women in Colorado were older and more significantly impacted by acute stroke. Risk factor profiles differed between the 2 genders, with men having a higher incidence of coronary artery disease, dyslipidemia, diabetes, carotid stenosis and tobacco smoking, while women had a higher incidence of atrial fibrillation and hypertension. Lipids were less aggressively treated and antithrombotics were less commonly used in women. Overall, acute stroke treatment of women appeared "less aggressive" than for men.
GGS may be used not only for quality improvement initiatives in individual hospitals. It can also give an overview of clinical aspects of stroke at a state level, and may shed light on gender differences.
中风方面的性别差异日益受到关注。美国中风协会的患者管理工具“遵循中风指南(GGS)”被广泛用于提高中风护理中对质量指标的依从性,但它也为分析急性中风情况下的性别差异提供了机会。
我们使用了一个基于GGS的全州数据库,以探索科罗拉多州中风的性别差异。我们分析了人口统计学、危险因素、生活方式、治疗方法以及对治疗的反应。
在检查的126个数据元素中,有47个(37%)存在统计学上显著的性别差异。与男性相比,科罗拉多州的女性年龄更大,受急性中风的影响更显著。两种性别的危险因素概况有所不同,男性患冠状动脉疾病、血脂异常、糖尿病、颈动脉狭窄和吸烟的发生率更高,而女性患心房颤动和高血压的发生率更高。女性的血脂治疗不够积极,抗血栓药物的使用也较少。总体而言,女性的急性中风治疗似乎比男性“更不积极”。
GGS不仅可用于个别医院的质量改进举措。它还可以概述州一级中风的临床情况,并可能揭示性别差异。