DIFFERENCES IN STROKE CARE AND OUTCOMES BETWEEN WOMEN AND MEN IN CANADA 

Authors: Thalia Field MD MHSc FRCPC, Noreen Kamal PhD, Patrice Lindsay PhD

Background:
Stroke in women is understudied.  We assessed sex differences in access to stroke treatment in Canada and stroke outcomes.

Methods:
We analyzed hospital administrative data from April 2009 to March 2016 using data from both the Canadian Institute for Health Information’s Discharge Abstract Database (DAD) for inpatient care, the National Ambulatory Care Reporting System (NACRS) for emergency care, and National Rehabilitation Reporting System (NRS) rehabilitation data. 

Results:
There were 257582 stroke patients during this 7-year period (49% female). Women were less likely to get tPA (13.7% vs. 14.2%)*, had longer door-to-needle times (average yearly median 103 min (SD 34) vs. 89 (35)*) and were more likely to die within 7 days of their event (8.5% vs. 7.9%)* Women also had worse dispositions, being discharged more often to long-term care (8.1% vs. 4.2%)* and being more likely to spending time with “alternate level of care” status (24% vs. 21%)* Women were less likely to be discharged home from a rehabilitation facility (64% vs. 70%)*, and were less likely to be discharged home without supports (41% vs. 49%)*. [*p<0.00001]

Conclusions:
Women are less likely to receive timely acute treatment for their strokes and experience worse outcomes in hospital and at discharge. Further study is needed to better understand these systemic differences and determine strategies to optimize equitable care.