Why do more women than men end up in nursing homes after stroke? Studies have shown that women are more likely to die after stroke and, if they survive, have worse functional outcomes. Most studies, though, have not found differences in stroke severity, say researchers from Frederiksberg University Hospital in Frederiksberg, Denmark; and University of Copenhagen and Danish Cancer Society, both in Copenhagen, Denmark. Their findings may help explain the paradoxes.
In this large study of 26,818 patients, 1,547 women and 1,186 men died within 3 months of having a stroke. Stroke severity was measured at admission to the hospital using the Scandinavian Stroke Scale (SSS), a neurologic scale that scores stroke from 0 (most severe) to 58 (least severe). Strokes were more severe in women (SSS score, 42.2) than in men (SSS score, 45.6). After adjusting for all cardiovascular risk factors for all patients, including 24,085 who survived 3 months after stroke, the researchers found nearly identical results in both groups: Women had more severe strokes.
Admission stroke severity in-creased significantly with age in both men and women but from about age 50 years (in all patients) and age 60 years (in 3-month survivors), strokes were more severe in women. The difference was significant when the patient was aged > 75 years. Nonetheless, women had better survival rates, with a significant difference between ages 78 and 90 years. Thus, they survive but live with the consequences of more severe strokes.
The absolute difference in mean admission SSS score between men and women was 3.3 points. The re-searchers note that in the Copenhagen Stroke Study, a mean 5-point increase in admission SSS score correlated to an estimated overall reduction of in-hospital mortality from 20.3% to 15.5%, a reduction in the percent-age of patients discharged to nursing home from 14.3% to 13.1%, and an increase in discharge to own home from 65.4% to 71.4%. In other words, they conclude, a 3.3-point difference can matter a lot.
Source
Olsen TS, Andersen ZJ, Andersen KK. Gend Med. 2012;9(3):147-153.
doi: 10.1016/j.genm.2012.03.002.