Introduction: Women may receive evidence-based care less often than men after stroke. It is uncertain whether this contributes to sex differences in outcomes. 

Methods: We included first-ever strokes admitted to 39 hospitals in the AuSCR during 2010-2014. Mortality 1-year after stroke was obtained from the National Death Index. HRQoL was measured by EQ5D-3L at 3-6 months follow-up. For women compared to men, we estimated the mortality rate ratio (MRR) using multilevel Poisson modelling (accounting for hospital) and the median differences (MD) in HRQoL using quantile regression. Study factors included sociodemographics, stroke type, severity (walking ability on admission) and evidence-based therapies (stroke unit care, thrombolysis, secondary prevention medications, dysphagia screening and mobilisation). 

Results: Data were available for 14,118 strokes (46% women, 81% ischaemic, median age: 75). Women were 7 years older and less able to walk on admission (29% vs 37%, p<0.001) than men. The only difference in evidence-based therapy was that women were less often administered aspirin ≤48 hours (51% vs 58%, p=0.014) in a Queensland subset (n=5,224). Mortality was greater in women (MRRcrude 1.45 [95% CI 1.33, 1.59]). Women’s lower aspirin administration, advanced age and stroke severity explained the difference (MRRadjusted 1.07 [0.97, 1.17]. About 60% (n=6852) had HRQoL assessments. Only older women compared to older men had poorer EQ5D utility (MD -0.103 [-0.160, -0.047]) independent of severity. The evidence-based care measures did not contribute to the difference.

Conclusion: Worse outcomes in women were associated with age, severity and aspirin administration suggesting targets to reduce sex differences in outcomes.

DIFFERENCES IN STROKE CARE AND OUTCOMES AFTER STROKE FOR WOMEN COMPARED TO MEN: AUSTRALIAN STROKE CLINICAL REGISTRY