Displaying One Session

e-Poster Discussion
Session Type
e-Poster Discussion
Room
Station 8 (E-Poster Area)
Date
07.11.2020, Saturday
Session Time
06:30 PM - 07:30 PM

STROKE INCIDENCE IS HIGHER IN YOUNG WOMEN THAN MEN IN A LARGE, NATIONAL UNITED STATES CLAIMS SAMPLE

Session Type
e-Poster Discussion
Date
07.11.2020, Saturday
Session Time
06:30 PM - 07:30 PM
Room
Station 8 (E-Poster Area)
Lecture Time
06:30 PM - 06:35 PM

Abstract

Background And Aims

Stroke incidence was thought to be higher in men than women except in the very elderly.1 In contrast, recent European data suggests stroke incidence may be higher in young women than men.2, 3 The goal of this study was to examine the rate of index strokes by sex in young adults over time in a large US sample.

Methods

A 10% random sample of Pharmetrics Legacy, a nationally representative US Claims Database,4 was analyzed. Patients were included if they were ≥15 years old and enrolled continuously for at least 6 months between 2001-2014. Stroke was defined as an inpatient admission with acute ischemic stroke as the primary diagnosis (using ICD-9 codes).5 Incidence rate ratio (IRR) men/women was calculated for each age group.

Results

Figure. Incidence Rate Ratio (IRR) by Age Groupsex differences_leppert.jpgApproximately, 5.8 million enrollees, including 20,554 index strokes (5,198 in young adults 15-54) were included. Stroke incidence was higher among women 25-34 and 35-44 (IRR < 1, Figure). The estimated IRR favored more women in the 15-24 age group, but did not reach statistical significance, due to the relatively low incidence of stroke (5.4/100,000 men, 6.7/100,000 women). In the 45-54 and 55 age groups, incident stroke rate was significantly higher for men (IRR >1).

Conclusions

Despite the protective effect of estrogen on athersclerosis6, more young women than men have strokes, pointing to the potential importance of sex-mediated etiologies of stroke. Understanding these drivers is critical to treatment and prevention efforts.

sex diff_leppert_ref.jpg

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SEX DIFFERENCES IN TOTAL AND ATTRIBUTABLE ONE-YEAR DIRECT MEDICAL COSTS OF ACUTE STROKE IN ONTARIO, CANADA

Session Type
e-Poster Discussion
Date
07.11.2020, Saturday
Session Time
06:30 PM - 07:30 PM
Room
Station 8 (E-Poster Area)
Lecture Time
06:35 PM - 06:40 PM
Presenter

Abstract

Background And Aims

The health and economic burden of stroke on Canadians are significant, but differences in resource use and cost related to sex are less understood. We aimed to compare the costs of stroke in women and men, from the perspective of the government payer (Ontario Ministry of Health).

Methods

In a retrospective population-based cohort study of adults admitted to hospital with ischemic or hemorrhagic stroke in Ontario between 2008 and 2017, we used linked administrative data to estimate costs in the year prior to and the year following the index admission. Healthcare costs attributable to stroke were calculated by subtracting the direct costs in the year pre-stroke from the costs in the year post-stroke. Costs were adjusted for inflation and expressed in 2018 Canadian dollars.

Results

Among 109,508 patients with stroke (87% ischemic, 49% women), women were older than men, had higher frailty scores, and had higher healthcare costs pre-stroke (mean cost [SD] per person of $17,719 [$29,977] women vs $14,509 [$28,713] men, p<0.001). The mean cost attributable to stroke was lower in women than men ($36,818 [$59,371] women vs $39,178 [$63,087] men, p<0.001). Compared to men, cost attributable to stroke was lower in women in acute care ($17,033 vs $18,301), outpatient care ($3,120 vs $4,154), and rehabilitation ($8,022 vs $8,906), but higher in long-term care ($1,949 vs $1,276).

Conclusions

The mean cost attributable to stroke is higher in men than women, particularly in acute inpatient care, outpatient care, and rehabilitation institutions. However, women incur greater costs in long-term care than men.

Trial Registration Number

Not applicable

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SEX DIFFERENCES IN STROKE CARE - OBSERVATIONS FROM THE SWEDISH STROKE REGISTER 2005-2018

Session Type
e-Poster Discussion
Date
07.11.2020, Saturday
Session Time
06:30 PM - 07:30 PM
Room
Station 8 (E-Poster Area)
Lecture Time
06:40 PM - 06:45 PM

Abstract

Background And Aims

Previous studies of stroke management and outcome after stroke in Sweden reveal differences between men and women. Our aim was to analyze if these differences have altered over time.

Methods

All stroke events registered in Riksstroke, the Swedish Stroke Register during 2005-2018 were included. We performed unadjusted and age-stratified analyzes.

Results

We identified 335,183 events (161,939 women; 173,244 men). Women were older than men at stroke onset (mean age 78.1 vs. 73.3 years). In both sexes, there was an increase in the proportion of ischemic stroke patients receiving reperfusion therapy 2005-2018 (1.3-16.6% in women; 2.5-16.8% in men) and, among those with atrial fibrillation, oral anticoagulants at discharge (26.4-75.8% in women; 36.7-77.7% in men). There was an increased proportion of patients prescribed statins, but during the entire study period the proportion remained lower in women (31.7-75.3%) in comparison to men (42.6-83.5%). In addition, women were less likely to be treated at stroke or intensive care units (78.4-90.6%) than men (81.9-91.8%). In 2018, unadjusted 28-day case fatality was 14.9% in women and 10.8% in men. For patients under the age of 80, case fatality was 7.2% in both women and men.

Conclusions

In this large nation-wide observational study, we report a more equal care between women and men. Still, women were less often prescribed statins and were less often treated at stroke units. One explanation to these differences could be women’s higher age at stroke onset, with a presumed frailty, but further analyzes are needed to investigate if the disparity is motivated.

Trial Registration Number

Not applicable

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SEX DIFFERENCES IN RECOVERY DURING INPATIENT REHABILITATION

Session Type
e-Poster Discussion
Date
07.11.2020, Saturday
Session Time
06:30 PM - 07:30 PM
Room
Station 8 (E-Poster Area)
Lecture Time
06:45 PM - 06:50 PM

Abstract

Background And Aims

We aimed to assess sex differences in functional improvement for stroke patients during inpatient rehabilitation.

Methods

We retrospectively reviewed stroke admissions to affiliated inpatient rehabilitation facilities after acute hospitalization from 10/2017 to 4/2019. Outcome measures included the Functional Independence Measure (FIM) total admission (FTA), FIM total improvement (FTI), and FIM components. The two-sample t-test was used to evaluate variables between sexes. Correlation between NIHSS and FTA was evaluated by Spearman correlation. Age, gender, FTA, initial stroke NIHSS, stroke type, HTN, DM, HLD, smoking status and prior stroke were tested in regression models for FTI.

Results

Of 225 patients, 40% were female. Although women were older than men (64.97 in women, 59.90 in men, p=0.006), there was no significant difference between FTIs or the components (mean FTI 25.6 women, 26.9 men, p=0.51) or in the amount of therapy provided. The NIHSS was negatively correlated to FTA (r=-0.52, 95% CI -0.62 to -0.40). Due to significant interaction effects on sexes, separate regression models were constructed. In the regression model for age in men, one-year senior led to a decrease of 0.37 on FTI (Fig 1). A second-order polynomial regression model was fitted for women with FTA affecting FTI (Fig 2). male.jpgfemale.jpg

Conclusions

Women with stroke were on average older than men but their age did not impact functional gains during inpatient rehabilitation. Men with stroke, however, showed less functional improvement with increasing age. We found a clear relationship between stroke severity and functional improvement only in women but with diminishing return as FTA approached maximum scores.

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SEX AND GENDER DISPARITIES IN CANADIAN NEUROVASCULAR MEDICINE

Session Type
e-Poster Discussion
Date
07.11.2020, Saturday
Session Time
06:30 PM - 07:30 PM
Room
Station 8 (E-Poster Area)
Lecture Time
06:50 PM - 06:55 PM

Abstract

Group Name

On behalf of the CANadian Women IN Neurovascular Medicine (CAN-WIN)

Background And Aims

Women are commonly promoted at a slower rate and are underrepresented as invited speakers at scientific meetings and in academic leadership positions. Our aim was to assess gender equity and disparities in neurovascular medicine in Canada.

Methods

The CANadian Women In Neurovascular medicine (CAN-WIN) is a professional group of female and male physicians, health professionals and researchers, established in 2017 with the aim of promoting sex/gender equity in neurovascular medicine. To describe demographics and professional needs, we asked all Canadian Stroke Consortium members to participate in a survey related to professional profile, mentorship experience, conference invitations and leadership positions.

Results

The survey was sent to 890 members. During a 2-month (08-10/19) period 137 responded (16% response rate). The majority (70%) were 35-55 years old; 108 identified as female (F) and 29 as male (M) and 80%M vs.53%F worked in academic settings. Among members working in academic setting (n=81,72%F) fewer females were at a senior academic level (18% vs.47%, p=0.03). Twice as many females (52% vs.26%, p=0.03) reported no invitations to speak at scientific meetings in the past three years. In an analysis only of physicians (n=61, 58%F), male reported holding active leadership positions more often than female (76% vs.50%).

Conclusions

In our population, women more often had junior academic positions than their male counterparts. Women were less likely to be invited speakers at meetings and held fewer leadership positions. Career development strategies should be designed to promote greater representation and early career participation of women in academic neurovascular medicine.

Trial Registration Number

Not applicable

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VARIATIONS BY AGE, SEX AND DEPRIVATION CATEGORY IN THE PRESCRIBING OF SECONDARY PREVENTION MEDICATIONS AFTER STROKE IN SCOTLAND: A NATIONAL DATABASE STUDY.

Session Type
e-Poster Discussion
Date
07.11.2020, Saturday
Session Time
06:30 PM - 07:30 PM
Room
Station 8 (E-Poster Area)
Lecture Time
06:55 PM - 07:00 PM

Abstract

Background And Aims

Background: Optimal medication treatment after stroke is important in preventing recurrent stroke events. Age, sex and socioeconomic factors (deprivation categories) have been shown to impact treatment and outcomes in patients with cardiovascular disease across different populations.

Aims: To evaluate the effect of age, sex and zones of deprivation on prescribing patterns for secondary prevention after an index stroke in Scotland.

Methods

Methods: The Scottish Stroke Care Audit linked with routine datasets (Prescribing Information System and Scottish Morbidity Record) was used to identify one-year stroke survivors from 2010 to 2015. Using logistic regression, patients receiving selected secondary prevention within six months after index stroke were assessed based on age, sex and deprivation quintiles.

Results

Results: Of the 44 835 index stroke survivors recorded, 22 613 (50.4%) were males and 22 222 (49.6%) were females (mean age 68.4 [±13.0] and 72.1 [±13.9] years respectively). Compared with male patients, females were less likely to be prescribed any antithrombotic, angiotensin-converting enzyme inhibitor, calcium-channel blocker or statin medication. Increasing age was associated with more prescriptions for anticoagulants and antihypertensive drugs. However, antiplatelets and statins were less likely to be prescribed to the oldest group (≥ 85 years) compared with patients in the youngest group (<65 years). Living in the least deprived quintile was associated with more prescriptions for anticoagulants, beta-blockers and angiotensin-receptor blockers, while the opposite was true for antiplatelet and statin prescriptions.

Conclusions

Conclusion: These results indicate significant variations in secondary prevention prescribing patterns in stroke survivors in Scotland based on age, sex and deprivation living zones.

Trial Registration Number

"Not applicable"

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Sex Differences in the Norwegian Tenecteplase Trial (NOR-TEST)

Session Type
e-Poster Discussion
Date
07.11.2020, Saturday
Session Time
06:30 PM - 07:30 PM
Room
Station 8 (E-Poster Area)
Lecture Time
07:00 PM - 07:05 PM

Abstract

Group Name

The Norwegian Stroke Project (NORSTROKE)

Background And Aims

There is a sex gap in cerebrovascular medicine, and women tend to be underrepresented in both clinical trials and acute treatment. We aimed to explore sex differences in baseline characteristics in Norwegian intravenous thrombolysis treated patients included in the Norwegian Tenecteplase Trial (NOR-TEST).

Methods

NOR-TEST is an open label, randomized, blinded endpoint trial comparing treatment with tenecteplase to alteplase in patients with acute ischemic stroke, eligible for treatment with intravenous thrombolysis within 4.5 hours after symptom onset.

Results

Of the 1100 patients enrolled, 40 % were women, but among patients >80 years there were more women compared to men (19 % vs. 14%, p=0.01). Women had a lower burden of cardiovascular risk factors, such as diabetes mellitus (11% vs. 15%, p=0.05), higher mean HDL level (1.7±0.6 vs. 1.3±0.4, p<0.001) and a higher proportion had never smoked (45% vs. 33%, p<0.001). A stroke mimic diagnosis was more common in women (21% vs. 15%, p=0.07). Women presented to hospital later (73.4±160.9 vs. 46.8±244.3, p=0.04), and had higher NIHSS at admission (6.2±5.6 vs. 5.33±5.1, p=0.01), with more often motor function impairment (65% vs. 54%, p<0.001), mainly driven by left sided symptoms.

Conclusions

Women were underrepresented in the NOR-TEST trial. The included women more often had stroke mimic diagnosis, lower cardiovascular risk factor burden than men, but more severe symptoms. Reasons for lower representation of women in intravenous thrombolysis trials should be explored in future research.

Trial Registration Number

Clinicaltrials.gov, number NCT01949948

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THE CONTRIBUTION OF FEMALE SPECIFIC RISK FACTORS IN PREDICTION OF STROKE USING ROUTINELY OBTAINED PRIMARY CARE DATA

Session Type
e-Poster Discussion
Date
07.11.2020, Saturday
Session Time
06:30 PM - 07:30 PM
Room
Station 8 (E-Poster Area)
Lecture Time
07:05 PM - 07:10 PM

Abstract

Background And Aims

Currently, only traditional cardiovascular risk factors are used for cardiovascular disease (CVD) risk prediction primary care. We investigated the added value of female specific risk factors in population-based prediction of stroke using routinely collected primary care data.

Methods

The research population consists of patients from the LUMC primary care network in the Netherlands. Inclusion criteria were female sex, age 18-65, and no history of CVD or statin prescription. We created a landmark dataset with landmarks every year. Two models of stroke risk were developed. The first model included the traditional risk factors age, sex, smoking, hypertension, diabetes, and hyperlipidemia. The second model additionally included female specific risk factors (migraine, complications during pregnancy, hormonal contraceptive use, and hormonal replacement therapy). For both models we used multivariable Cox regression to obtain the concordance-index, and internally validated results using 5-fold cross-validation. We corrected the standard error for clustering in the landmarked dataset.

Results

We included 27065 women with a mean age of 43 years and an average follow-up time of 7.2 years, of whom 83 (0.3%) developed a stroke. The concordance-index was 0.75 (95%CI:0.70-0.80) for the traditional vascular risk factor model, and 0.77 (95%CI:0.72-0.82) for the model including additional female specific risk factors.

Conclusions

In young to middle-aged women, including female specific risk factors in prediction models predicting stroke only marginally increased the concordance-index. A study with a larger sample size is needed to conclusively determine added value of female specific risk factors in predicting stroke.

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