Original Article

OPEN: Sex Differences in Stroke Hospitalization Incidence, 30-Day Mortality, and Readmission in a Regional Medical Center in the Southwestern United States

Authors: Jeff A. Dennis, PhD, Yan Zhang, PhD, Fangyuan Zhang, PhD, Noah De La Cruz, MPH, Greg Hannabas, MD, MPH, MPA, Nan Mi, MA

Abstract

Objectives: This study explores sex differences in ischemic stroke hospitalization incidence, 30-day mortality, and 30-day readmission in a southwestern US medical center.

Methods: Ischemic stroke admissions in a regional medical center in the southwestern United States were obtained for a 6.5-year time frame (N = 1968). Logistic regression models examine the adjusted effects of sex on 30-day mortality and 30-day readmission outcomes among individuals hospitalized for ischemic stroke.

Results: Findings confirm that although women experience higher mortality than men (9.1% vs 6.7%), the sex disparity in mortality is explained by the age distribution of strokes. Women experience far more strokes and deaths because of stroke at older ages. No differences in principal procedure or 30-day readmission emerged.

Conclusions: Men experienced higher stroke hospitalization incidence, although women exhibited higher 30-day mortality. Age composition explained sex differences in mortality, but higher male stroke hospitalization incidence represents a larger public health issue that suggests the need for behavioral change at the population level. No meaningful sex differences emerged in treatment, mortality, or readmission.
Posted in: Neurology16

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Table 1. Sample characteristics of individuals hospitalized for ischemic stroke, by sex

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Fig. 1. Ischemic stroke hospitalization incidence by age and sex, January 2013–June 2019.

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Fig. 2. Frequency of 30-d mortality among individuals hospitalized for ischemic stroke, by age and sex, January 2013–June 2019.

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Fig. 3. Age-specific mortality percentages among individuals hospitalized for ischemic stroke, by sex, January 2013–June 2019.

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Table 2. Principal procedures among individuals hospitalized and for ischemic stroke, by sex and mortality

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Table 3. Multivariate logistic regression odds ratios predicting 30-d ischemic stroke mortality (N = 1967)

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References

1. National Academies of Sciences, Engineering, and Medicine. Communities in Action: Pathways to Health Equity. Washington, DC: The National Academies Press; 2017. 2. Benjamin EJ, Muntner P, Alonso A, et al. Heart disease and stroke statistics— 2019 update: a report from the American Heart Association. Circulation 2019;139:e56–e528.   3. Reeves MJ, Bushnell CD, Howard G, et al. Sex differences in stroke: epidemiology, clinical presentation, medical care, and outcomes. Lancet Neurol 2008;7:915–926.   4. Howden LM, Meyer JA. Age and sex composition, 2010. https://www.census.gov/prod/cen2010/briefs/c2010br-03.pdf. Accessed January 9, 2021. 5. Christensen H, Bentsen L, Christensen L. Update on specificities of stroke in women. Presse Med 2016;45:e409–e418. 6. Guzman RP, Weighell W, Guzman C, et al. Female sex does not influence 30-day stroke and mortality rates after carotid endarterectomy. Ann Vasc Surg 2014;28:245–252. 7. Katsiki N, Ntaios G, Vemmos K. Stroke, obesity and gender: a review of the literature. Maturitas 2011;69:239–243. 8. Mozaffarian D, Benjamin EJ, Go AS, et al. Heart disease and stroke statistics— 2016 update: a report from the American Heart Association. Circulation 2016;133:e38–e360. 9. Girijala RL, Sohrabji F, Bush RL. Sex differences in stroke: review of current knowledge and evidence. Vasc Med 2017;22:135–145. 10. Appelros P, Stegmayr B, Terént A. Sex differences in stroke epidemiology: a systematic review. Stroke 2009;40:1082–1090. 11. Chalos V, de Ridder IR, Lingsma HF, et al. Does sex modify the effect of endovascular treatment for ischemic stroke? A subgroup analysis of 7 randomized trials. Stroke 2019;50:2413–2419. 12. Hiraga A. Gender differences and stroke outcomes. Neuroepidemiology 2017;48:61–62. 13. Mizrahi EH, Waitzman A, Arad M, et al. Gender and the functional outcome of elderly ischemic stroke patients. Arch Gerontol Geriat 2012;55:438–441. 14. Sohrabji F, Park MJ, Mahnke AH. Sex differences in stroke therapies. J Neurosci Res 2017;95:681–691. 15. Sheth SA, Lee S, Warach SJ, et al. Sex differences in outcome after endovascular stroke therapy for acute ischemic stroke. Stroke 2019;50:2420–2427. 16. Fehnel CR, Lee Y, Wendell LC, et al. Post-acute care data for predicting readmission after ischemic stroke: a nationwide cohort analysis using the minimum data set. J Am Heart Assoc 2015;4:e002145. 17. Nouh AM, McCormick L, Modak J, et al. High mortality among 30-day readmission after stroke: predictors and etiologies of readmission. Front Neurol 2017;8:632. 18. Rao A, Barrow E, Vuik S, et al. Systematic review of hospital readmissions in stroke patients. Stroke Res Treat 2016;2016:1–11. 19. Conroy RM. What hypotheses do “nonparametric” two-group tests actually test? Stata J 2012;12:182–190. 20. Felipe RA, Plescia M, Peterman E, et al. A public health framework to improve population health through health care and community clinical linkages: the ASTHO/CDC Heart Disease and Stroke Prevention Learning Collaborative. Prev Chronic Dis 2019;16:E124. 21. Salinas J, Schwamm LH. Behavioral interventions for stroke prevention: the need for a new conceptual model. Stroke 2017;48:1706–1714.