Sex Disparities in Ischemic Stroke Care: FL-PR CReSD Study (Florida-Puerto Rico Collaboration to Reduce Stroke Disparities)

Negar Asdaghi, Jose G. Romano, Kefeng Wang, Maria A. Ciliberti-Vargas, Sebastian Koch, Hannah Gardener, Chuanhui Dong, David Z. Rose, Salina P. Waddy, Mary Robichaux, Enid J. Garcia, Juan A. Gonzalez-Sanchez, W. Scott Burgin, Ralph L. Sacco, Tatjana Rundek

Research output: Contribution to journalArticle

18 Scopus citations

Abstract

Background and Purpose - Sex-specific disparities in stroke care including thrombolytic therapy and early hospital admission are reported. In a large registry of Florida and Puerto Rico hospitals participating in the Get With The Guidelines - Stroke program, we sought to determine sex-specific differences in ischemic stroke performance metrics and overall thrombolytic treatment. Methods - Around 51 317 (49% women) patients were included from 73 sites from 2010 to 2014. Multivariable logistic regression with generalized estimating equations evaluated sex-specific differences in the prespecified Get With The Guidelines - Stroke metrics for defect-free care in ischemic stroke, adjusting for age, race-ethnicity, insurance status, hospital characteristics, individual risk factors, and the presenting stroke severity. Results - As compared with men, women were older (73±15 versus 69±14 years; P<0.0001), more hypertensive (67% versus 63%, P<0.0001), and had more atrial fibrillation (19% versus 16%; P<0.0001). Defect-free care was slightly lower in women than in men (odds ratio, 0.96; 95% confidence interval, 0.93-1.00). Temporal trends in defect-free care improved substantially and similarly for men and women, with a 29% absolute improvement in women (P<0.0001) and 28% in men (P<0.0001), with P value of 0.13 for time-by-sex interaction. Women were less likely to receive thrombolysis (odds ratio, 0.92; 95% confidence interval, 0.86-0.99; P=0.02) and less likely to have a door-to-needle time <1 hour (odds ratio, 0.83; 95% confidence interval, 0.71-0.97; P=0.02) as compared with men. Conclusions - Women received comparable stroke care to men in this registry as measured by prespecified Get With The Guidelines metrics. However, women less likely received thrombolysis and had door-to-needle time <1 hour, an observation that calls for the implementation of interventions to reduce sex disparity in these measures.

Original languageEnglish (US)
Pages (from-to)2618-2626
Number of pages9
JournalStroke
Volume47
Issue number10
DOIs
StatePublished - Oct 1 2016

Keywords

  • Get With The Guidelines
  • National Institute of Neurological Disorders and Stroke
  • sex characteristics
  • stroke

ASJC Scopus subject areas

  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine
  • Advanced and Specialized Nursing

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  • Cite this

    Asdaghi, N., Romano, J. G., Wang, K., Ciliberti-Vargas, M. A., Koch, S., Gardener, H., Dong, C., Rose, D. Z., Waddy, S. P., Robichaux, M., Garcia, E. J., Gonzalez-Sanchez, J. A., Burgin, W. S., Sacco, R. L., & Rundek, T. (2016). Sex Disparities in Ischemic Stroke Care: FL-PR CReSD Study (Florida-Puerto Rico Collaboration to Reduce Stroke Disparities). Stroke, 47(10), 2618-2626. https://doi.org/10.1161/STROKEAHA.116.013059