Disparities in Stroke Treatment Seen for Men, Women

SAN DIEGO — Women have strokes more often than men, but they are significantly less likely to receive the best available treatment, according to two studies presented at the International Stroke Conference.

In a meta-analysis of 18 studies involving more than 2.3 million men and women who had a stroke, Dr. Archit Bhatt of Michigan State University, East Lansing, determined that women were 30% less likely than men to receive intravenous tissue plasminogen activator (TPA), the most effective treatment known. This difference was statistically significant.

Of the 21,503 patients who received TPA, 63% were male and 37% were female.

The sex disparity persisted even after Dr. Bhatt adjusted for differences in age and other confounders. In the adjusted analysis, women were 23% less likely to receive TPA than men were (Stroke 2009 Feb. 19 [doi:10.1161/STROKEAHA.108.543181

“At this point there are no gender-based guidelines to give TPA,” Dr. Bhatt noted during a news conference. “So clearly more research needs to be done to understand the barriers to acute stroke therapy in women, so that critical health disparities can be eliminated.”

In a separate study, Dr. Louise D. McCullough of the University of Connecticut, Farmington, and her colleagues determined that on average, women arrive at the emergency department 12 minutes later than men do.

In a retrospective analysis of 435 stroke patients, aged 45 years and older, who were treated at a single emergency department, the average man arrived 96.4 minutes after the onset of symptoms, compared with 108.8 minutes for women, a significant difference.

Later arrival can have a large impact on treatment and outcome, since TPA must be administered no later than 3 hours after the onset of stroke symptoms.

“The one encouraging thing in our study that we found is that once [women] were in our emergency room, they were treated exactly the same way as men,” Dr. McCullough said at the news conference. “They were treated with the same speed, and they were treated at the same rate as men. The problem was they were losing a lot of time getting there.”

Although the data did not allow the investigators to determine why women were arriving later, Dr. McCullough offered several hypotheses.

For one thing, women tend to be older than men when they have their stroke.

In addition, a woman may be living alone, having survived her husband, and there may not be anyone available to contact authorities.

Another factor may be that “they don't have the same level of urgency that men have, and it could be they're not identifying their own atypical presentations,” Dr. McCullough said.

“I think also women tend to minimize symptoms. We've seen that in heart disease,” she added.

Dr. Bhatt and Dr. McCullough both stated that they had no conflicts of interest to disclose.

SAN DIEGO — Women have strokes more often than men, but they are significantly less likely to receive the best available treatment, according to two studies presented at the International Stroke Conference.

In a meta-analysis of 18 studies involving more than 2.3 million men and women who had a stroke, Dr. Archit Bhatt of Michigan State University, East Lansing, determined that women were 30% less likely than men to receive intravenous tissue plasminogen activator (TPA), the most effective treatment known. This difference was statistically significant.

Of the 21,503 patients who received TPA, 63% were male and 37% were female.

The sex disparity persisted even after Dr. Bhatt adjusted for differences in age and other confounders. In the adjusted analysis, women were 23% less likely to receive TPA than men were (Stroke 2009 Feb. 19 [doi:10.1161/STROKEAHA.108.543181

“At this point there are no gender-based guidelines to give TPA,” Dr. Bhatt noted during a news conference. “So clearly more research needs to be done to understand the barriers to acute stroke therapy in women, so that critical health disparities can be eliminated.”

In a separate study, Dr. Louise D. McCullough of the University of Connecticut, Farmington, and her colleagues determined that on average, women arrive at the emergency department 12 minutes later than men do.

In a retrospective analysis of 435 stroke patients, aged 45 years and older, who were treated at a single emergency department, the average man arrived 96.4 minutes after the onset of symptoms, compared with 108.8 minutes for women, a significant difference.

Later arrival can have a large impact on treatment and outcome, since TPA must be administered no later than 3 hours after the onset of stroke symptoms.

“The one encouraging thing in our study that we found is that once [women] were in our emergency room, they were treated exactly the same way as men,” Dr. McCullough said at the news conference. “They were treated with the same speed, and they were treated at the same rate as men. The problem was they were losing a lot of time getting there.”

Although the data did not allow the investigators to determine why women were arriving later, Dr. McCullough offered several hypotheses.

For one thing, women tend to be older than men when they have their stroke.

In addition, a woman may be living alone, having survived her husband, and there may not be anyone available to contact authorities.

Another factor may be that “they don't have the same level of urgency that men have, and it could be they're not identifying their own atypical presentations,” Dr. McCullough said.

“I think also women tend to minimize symptoms. We've seen that in heart disease,” she added.

Dr. Bhatt and Dr. McCullough both stated that they had no conflicts of interest to disclose.

SAN DIEGO — Women have strokes more often than men, but they are significantly less likely to receive the best available treatment, according to two studies presented at the International Stroke Conference.

In a meta-analysis of 18 studies involving more than 2.3 million men and women who had a stroke, Dr. Archit Bhatt of Michigan State University, East Lansing, determined that women were 30% less likely than men to receive intravenous tissue plasminogen activator (TPA), the most effective treatment known. This difference was statistically significant.

Of the 21,503 patients who received TPA, 63% were male and 37% were female.

The sex disparity persisted even after Dr. Bhatt adjusted for differences in age and other confounders. In the adjusted analysis, women were 23% less likely to receive TPA than men were (Stroke 2009 Feb. 19 [doi:10.1161/STROKEAHA.108.543181

“At this point there are no gender-based guidelines to give TPA,” Dr. Bhatt noted during a news conference. “So clearly more research needs to be done to understand the barriers to acute stroke therapy in women, so that critical health disparities can be eliminated.”

In a separate study, Dr. Louise D. McCullough of the University of Connecticut, Farmington, and her colleagues determined that on average, women arrive at the emergency department 12 minutes later than men do.

In a retrospective analysis of 435 stroke patients, aged 45 years and older, who were treated at a single emergency department, the average man arrived 96.4 minutes after the onset of symptoms, compared with 108.8 minutes for women, a significant difference.

Later arrival can have a large impact on treatment and outcome, since TPA must be administered no later than 3 hours after the onset of stroke symptoms.

“The one encouraging thing in our study that we found is that once [women] were in our emergency room, they were treated exactly the same way as men,” Dr. McCullough said at the news conference. “They were treated with the same speed, and they were treated at the same rate as men. The problem was they were losing a lot of time getting there.”

Although the data did not allow the investigators to determine why women were arriving later, Dr. McCullough offered several hypotheses.

For one thing, women tend to be older than men when they have their stroke.

In addition, a woman may be living alone, having survived her husband, and there may not be anyone available to contact authorities.

Another factor may be that “they don't have the same level of urgency that men have, and it could be they're not identifying their own atypical presentations,” Dr. McCullough said.

“I think also women tend to minimize symptoms. We've seen that in heart disease,” she added.

Dr. Bhatt and Dr. McCullough both stated that they had no conflicts of interest to disclose.