Sex differences in etiologies, risk factors, and outcomes among young adult patients with acute ischemic stroke.

BACKGROUND

The incidence of ischemic stroke is increasing among young adults. Several studies have demonstrated sex differences in risk and outcomes; however, findings are inconsistent. We sought to evaluate sex differences in stroke risk factors, etiology, and disposition in a diverse cohort of patients admitted to a comprehensive stroke center for evaluation.

METHODS

We conducted a retrospective study of patients 18-45 years admitted between January 1, 2015 and September 30, 2021 with an acute ischemic stroke. Patient demographics, risk factors, and disposition were extracted from our institutional inpatient stroke registry and inpatient electronic medical record. Stroke etiology was assigned based on record review. Bivariate analyses were conducted between sex and demographic variables, risk factors, stroke etiology, and disposition.

RESULTS

Among 785 patients included, 48.9% (n=384) were female and 51.1% (n=401) were male. Female patients had a higher proportion of prior strokes, cardiac/pulmonary shunts, autoimmune disorders, history of migraine headaches, and exogenous hormone use with a higher proportion of ischemic strokes of other etiologies. Male patients had a higher proportion of lower left ventricular ejection fraction, atrial fibrillation, substance use, and obstructive sleep apnea with a higher proportion of ischemic strokes due to small vessel occlusions and cardioembolic sources. There was a comparable proportion of traditional risk factors and strokes secondary to large artery atherosclerosis between the sexes. No sex differences were seen among functional outcomes at discharge; however, female patients had a lower inpatient mortality rate and lower odds of being discharged to skilled nursing facilities/long-term acute care hospitals/acute care facilities compared to male patients.

CONCLUSIONS

This study supports the known sex differences in stroke risk factors, etiology, and outcomes for ischemic stroke in young patients, showing the relationship also remains applicable in a large, diverse population. Strategies to address these differences could improve stroke classification and stroke prevention efforts, improving outcomes in this age group.