Sex differences in stroke in a Sri Lankan cohort.

Abstract

Introduction: Stroke characteristics, subtypes and risk factors in women may differ from men. Data on sex differences in stroke are scarce in developing countries, especially the South Asian region. We aimed to describe the sex differences in patients with stroke admitted to a tertiary care hospital in Sri Lanka.

Methods: Consecutive patients with stroke enrolled in the Ragama Stroke Registry over 3 years (2020-2023) were studied. Sex differences in demographics, presentation delays, clinical characteristics, stroke subtypes, risk factors, stroke severity and early functional outcomes were compared using chi-square test, independent sample t-test and Wilcoxon rank sum test. Associations of early functional dependence were studied using multiple logistic regression.

Results: Of 949 patients with stroke, 387 (40.8%) were women, with a median age of 66 (IQR 57-73) years compared to 63 (IQR 54-70) years in men (p<0.001). Women had more ischaemic strokes (85.8% vs 78.6% in men, p=0.005). Swallowing difficulty (p=0.039) and bladder involvement (p=0.001) were more common in women, whereas dysarthria (p=0.002) and cerebellar signs (p=0.005) were more common in men. More women had hypertension (74.4% vs 59.4%, p<0.001) and diabetes (52.2% vs 41.6%, p=0.001), whereas smoking (35.1% vs 0.3%, p<0.001), alcohol use (55.0% vs 0.3%, p<0.001) and other substance abuse (5.2% vs 0.8%, p<0.001) were almost exclusively seen in men. No differences were noted in delays to hospital admission (delay ≥4.5 hours: women- 45.4% vs men-41.3%, p=0.222). There were no sex differences in the rates of CT scanning (women- 100% vs men- 99.6%, p=0.516) or thrombolysis for ischaemic stroke (women- 7.8% vs men- 10.2%, p=0.458), but more men received stroke unit care (men- 45.4% vs women- 37.2%, p=0.012). No differences were noted between sexes in the clinical (Oxfordshire classification, p=0.671) or aetiological (TOAST criteria, p=0.364) subtypes of stroke. Stroke severity on admission was similar between sexes (median NIHSS score; women- 8.0 vs men- 8.0, p=0.897). More women had a discharge Barthel index (BI) <60 than men (62.6% vs 53.5%, p=0.007), but female sex was not associated with BI<60 on multivariate logistic regression (p=0.134). There was no difference in in-hospital mortality (women-5.9% vs. men- 5.9%, p=0.963).

Conclusions: Women with stroke in this South Asian cohort were older, had different risk factor profiles and clinical stroke characteristics, and had more ischaemic strokes. Female sex was not independently associated with functional disability on discharge or in-hospital mortality.