Bonkhoff Anna K, Karch André, Weber Ralph, Wellmann Jürgen, Berger Klaus
J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston (A.K.B.).
Institute of Epidemiology and Social Medicine, University of Muenster, Germany (A.K.B., A.K., J.W., K.B.).
Stroke. 2021 Jan;52(2):406-415. doi: 10.1161/STROKEAHA.120.032850. Epub 2021 Jan 25.
Men and women are differently affected by acute ischemic stroke (AIS) in many aspects. Prior studies on sex disparities were limited by moderate sample sizes, varying years of data acquisition, and inconsistent inclusions of covariates leading to controversial findings. We aimed to analyze sex differences in AIS severity, treatments, and early outcome and to systematically evaluate the effect of important covariates in a large German stroke registry.
Analyses were based on the Stroke Registry of Northwestern Germany from 2000 to 2018. We focused on admission-stroke severity and disability, acute recanalization treatment, and early stroke outcomes. Potential sex divergences were investigated via odds ratio (OR) using logistic regression models. Covariates were introduced in 3 steps: (1) base models (age and admission year), (2) partially adjusted models (additionally corrected for acute stroke severity and recanalization treatment), (3) fully adjusted models (additionally adjusted for onset-to-admission time interval, prestroke functional status, comorbidities, and stroke cause). Models were separately fitted for the periods 2000 to 2009 and 2010 to 2018.
Data from 761 106 patients with AIS were included. In fully adjusted models, there were no sex differences with respect to treatment with intravenous thrombolysis (2000-2009: OR, 0.99 [95% CI, 0.94-1.03]; 2010-2018: OR, 1.0 [0.98-1.02]), but women were more likely to receive intraarterial therapy (2010-2018: OR, 1.12 [1.08-1.15]). Despite higher disability on admission (2000-2009: OR, 1.10 [1.07-1.13]; 2010-2018: OR, 1.09 [1.07-1.10]), female patients were more likely to be discharged with a favorable functional outcome (2003-2009: OR, 1.05 [1.02-1.09]; 2010-2018: OR, 1.05 [1.04-1.07]) and experienced lower in-hospital mortality (2000-2009: OR, 0.92 [0.86-0.97]; 2010-2018: OR, 0.91 [0.88-0.93]).
Female patients with AIS have a higher chance of receiving intraarterial treatment that cannot be explained by clinical characteristics, such as age, premorbid disability, stroke severity, or cause. Women have a more favorable in-hospital recovery than men because their higher disability upon admission was followed by a lower in-hospital mortality and a higher likelihood of favorable functional outcome at discharge after adjustment for covariates.
男性和女性在急性缺血性卒中（AIS）的许多方面受到的影响有所不同。先前关于性别差异的研究受到样本量适中、数据采集年份不同以及协变量纳入不一致等因素的限制，导致研究结果存在争议。我们旨在分析AIS严重程度、治疗方法和早期结局方面的性别差异，并在一个大型德国卒中登记处系统评估重要协变量的影响。
分析基于2000年至2018年德国西北部卒中登记处的数据。我们重点关注入院时的卒中严重程度和残疾情况、急性再通治疗以及早期卒中结局。通过使用逻辑回归模型的优势比（OR）来研究潜在的性别差异。协变量分三步引入：（1）基础模型（年龄和入院年份），（2）部分调整模型（另外校正急性卒中严重程度和再通治疗），（3）完全调整模型（另外调整发病至入院时间间隔、卒中前功能状态、合并症和卒中病因）。模型分别针对2000年至2009年和2010年至2018年这两个时间段进行拟合。
纳入了761106例AIS患者的数据。在完全调整模型中，静脉溶栓治疗方面不存在性别差异（2000 - 2009年：OR，0.99[95%CI，0.94 - 1.03]；2010 - 2018年：OR，1.0[0.98 - 1.02]），但女性更有可能接受动脉内治疗（2010 - 2018年：OR，1.12[1.08 - 1.15]）。尽管入院时残疾程度较高（2000 - 2009年：OR，1.10[1.07 - 1.13]；2010 - 2018年：OR，1.09[1.07 - 1.10]），但女性患者更有可能在出院时获得良好的功能结局（2003 - 2009年：OR，1.05[1.02 - 1.09]；2010 - 2018年：OR，1.05[1.04 - 1.07]），且住院死亡率较低（2000 - 2009年：OR，0.92[0.86 - 0.97]；2010 - 2018年：OR，0.91[0.88 - 0.93]）。
患有AIS的女性患者接受动脉内治疗的机会更高，这无法用年龄、病前残疾、卒中严重程度或病因等临床特征来解释。女性在住院期间的恢复情况比男性更有利，因为在调整协变量后，她们入院时较高的残疾程度之后是较低的住院死亡率和出院时获得良好功能结局的更高可能性。
