According to a study published in Neurology, women are at a greater risk for poor functional outcome and participation restriction after stroke compared with men. This risk, however, is greatly attenuated when adjusted for age, stroke severity, and prestroke dependency.

In the meta-analysis, a total of 11 stroke incidence studies conducted between 1993 and 2014 that reported long-term functional outcomes were included. Investigators estimated the female-to-male relative risk (RR) for poor functional outcome, defined as a modified Rankin Scale score >2 or Barthel Index score <20, at 1 year (n=4852) and 5 years (n=2226). In addition, investigators used the London Handicap Scale (range, 0-100, with higher scores indicating improved outcomes) to assess participation restriction among women and men at 5 years (n=617).

The crude analysis of the pooled data found that women experienced substantially worse poststroke functional outcomes compared with men at 1 year (RR, 1.32; 95% CI, 1.18-1.48) and 5 years (RR, 1.31; 95% CI, 1.16-1.47). Compared with men, female patients were typically older, often lived with a spouse, and were more dependent before stroke.

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There was no difference between groups when investigators adjusted for age, stroke severity, and prestroke dependency at 1 year (adjusted RR [aRR], 1.08; 95% CI, 0.97-1.20) or 5 years (aRR 1.05; 95% CI, 0.94-1.18). Although women demonstrated greater participation restriction compared with men in the unadjusted analysis (mean difference [MD], −5.55; 95% CI, −8.47 to −2.63), there was no difference between men and women after accounting for age, stroke severity, and prestroke dependency (adjusted MD, −2.48; 95% CI, −4.99 to 0.03).

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A limitation of the meta-analysis includes the lack of data on stroke management, as well as long-term outcomes in some of the included studies.

To narrow the gap between men and women in regard to long-term functional outcomes, the investigators suggest interventions such as “reducing the risk factors of stroke particularly in women and the elderly, as well as better measurement and management of functional limitations in women as they age.”


Phan HT, Blizzard CL, Reeves MJ, et al. Factors contributing to sex differences in functional outcomes and participation after stroke [published online April 27, 2018]. Neurology. doi: 10.1212/WNL.0000000000005602