Department of Medicine (Neurology), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
Sunnybrook Research Institute, Toronto, Ontario, Canada.
Can J Neurol Sci. 2020 Mar;47(2):153-159. doi: 10.1017/cjn.2019.335.
Women are more likely to be admitted to nursing home after stroke than men. Differences in patient characteristics and outcomes by sex after institutionalization are less understood. We examined sex differences in the characteristics and care needs of patients admitted to nursing home following stroke and their subsequent survival.
We identified patients with stroke newly admitted to nursing home between April 2011 and March 2016 in Ontario, Canada, with follow-up until March 2018 using linked administrative data. We calculated prevalence ratios and 95% confidence intervals (CIs) for the primary outcomes of dependence for activities of daily living, cognitive impairment, frailty, health instability, and symptoms of depression or pain, comparing women to men. The secondary outcome was all-cause mortality.
Among 4831 patients, 60.9% were women. Compared to men, women were older (median age [interquartile range, IQR]: 84 [78, 89] vs. 80 [71, 86]), more likely to be frail (prevalence ratio 1.14, 95% CI [1.08, 1.19]), have unstable health (1.45 [1.28, 1.66]), and experience symptoms of depression (1.25 [1.11, 1.40]) or pain (1.21 [1.13, 1.30]), and less likely to have aggressive behaviors (0.87 [0.80, 0.94]). Overall median survival was 2.9 years. In a propensity-score-matched cohort, women had lower mortality than men (hazard ratio 0.85, 95% CI [0.77, 0.94]), but in the age-stratified survival analysis, the survival advantage in women was limited to those aged 75 years and older.
Despite lower subsequent mortality, women admitted to nursing home after stroke required more care than men. Pain and depression are two treatable symptoms that disproportionately affect women.
女性在中风后比男性更有可能入住疗养院。关于住院后患者特征和结局的性别差异了解较少。本研究旨在探究中风后入住疗养院的患者的特征和护理需求及其随后的生存情况中的性别差异。
我们使用链接的行政数据，确定了 2011 年 4 月至 2016 年 3 月期间在加拿大安大略省新入住疗养院的中风患者，并随访至 2018 年 3 月。我们计算了主要结局（日常生活活动依赖、认知障碍、衰弱、健康不稳定以及抑郁或疼痛症状）的患病率比和 95%置信区间（CI），并将女性与男性进行比较。次要结局是全因死亡率。
在 4831 名患者中，60.9%为女性。与男性相比，女性年龄更大（中位数[四分位距，IQR]：84 [78，89] 岁 vs. 80 [71，86] 岁）、更易衰弱（患病率比 1.14，95%CI [1.08，1.19]）、健康状况不稳定（1.45 [1.28，1.66]）、出现抑郁（1.25 [1.11，1.40]）或疼痛（1.21 [1.13，1.30]）的可能性更大，出现攻击性行为的可能性更小（0.87 [0.80，0.94]）。总体中位生存期为 2.9 年。在倾向评分匹配队列中，女性的死亡率低于男性（风险比 0.85，95%CI [0.77，0.94]），但在年龄分层生存分析中，女性的生存优势仅限于 75 岁及以上的患者。
尽管随后的死亡率较低，但入住疗养院的女性比男性需要更多的护理。疼痛和抑郁是两种影响女性的可治疗症状。
