Department of Health Care Administration and Management, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Cerebrovasc Dis. 2023;52(4):409-416. doi: 10.1159/000526940. Epub 2023 Feb 8.
Data on sex differences in poststroke functional status for a period longer than 1 year based on large cohorts are sparse. This study aimed to determine whether there are sex differences in long-term functional decline after ischemic stroke.
We tracked functional status for 5 years among 3-month survivors of acute ischemic stroke and compared outcomes between women and men using a large-scale hospital-based stroke registry in Fukuoka, Japan. Functional status was assessed using the modified Rankin Scale (mRS). Functional dependency was defined as an mRS score of 3, 4, or 5. Logistic regression analysis was used to estimate odds ratios (ORs) and 95% confidence intervals of outcomes after adjusting for possible confounders.
A total of 8,446 patients (71.9 ± 12.5 years, 3,377 (40.0%) female patients) were enrolled in this study. Female sex was associated with a higher risk of functional dependency at 5 years poststroke even when adjusting for age, 3-month mRS score, and other confounding factors (multivariable-adjusted OR vs. men, 1.56 [95% confidence interval, 1.26-1.93]). This significant association of female sex with higher dependency at 5 years was also found among patients who were independent at 3 months poststroke. Subgroup analysis showed that increased risk of functional dependency in female patients was more marked in patients aged ≥75 years than in those aged <75 years (p for heterogeneity = 0.02). Conversely, female sex was associated with a lower risk of death. No sex difference was observed in stroke recurrence during 5 years poststroke.
DISCUSSION/CONCLUSION: This longitudinal observational study suggests that female sex was independently associated with an increased risk of functional decline in the chronic phase of stroke, especially in older patients. There was no sex difference in 5-year stroke recurrence, and thus, other factors might be involved in more significant deterioration of functional status in female survivors of ischemic stroke. Further studies are needed to elucidate underlying causes of sex differences in long-term functional decline after stroke.
基于大型队列的超过 1 年的卒中后功能状态的性别差异数据较为匮乏。本研究旨在确定缺血性卒中后长期功能下降是否存在性别差异。
我们对日本福冈市一个大型基于医院的卒中登记处的急性缺血性卒中 3 个月幸存者进行了 5 年的功能状态随访，并比较了女性和男性的结局。采用改良 Rankin 量表（mRS）评估功能状态。功能依赖定义为 mRS 评分 3、4 或 5。使用逻辑回归分析来估计调整了可能混杂因素后的结局的比值比（OR）和 95%置信区间。
共纳入 8446 例患者（71.9 ± 12.5 岁，3377 例[40.0%]为女性）。即使在调整年龄、3 个月 mRS 评分和其他混杂因素后，女性性别与卒中后 5 年时功能依赖的风险更高相关（多变量校正后 OR 比男性，1.56[95%置信区间，1.26-1.93]）。在 3 个月时功能独立的患者中也发现了女性性别与 5 年时更高依赖性的显著关联。亚组分析表明，在年龄≥75 岁的患者中，女性患者功能依赖风险增加更为明显，而在年龄<75 岁的患者中则不明显（组间差异的 p 值=0.02）。相反，女性性别与死亡风险降低相关。在卒中后 5 年内，未观察到性别差异的卒中复发。
讨论/结论：本纵向观察性研究表明，女性性别与卒中慢性期功能下降的风险增加独立相关，尤其是在老年患者中。在 5 年内，女性和男性的卒中复发无差异，因此，其他因素可能涉及缺血性卒中女性幸存者功能状态的更显著恶化。需要进一步的研究来阐明卒中后长期功能下降中性别差异的潜在原因。
