Gender Differences in Risk Factors, Mortality, and Length of Stay of Patients Discharged From a Pakistani Stroke Unit: A Comparative Cross-Sectional Study

Introduction

Stroke is the most common cause of sustained disability and the leading cause of mortality worldwide.1 Although most research and attention to prevention and intervention occurs in high-income countries, more than 85% of strokes occur in low- and middle-income countries.

Abstract

BACKGROUND

Differences between women and men in relation to stroke are increasingly being recognized. There is a scarcity of data on gender-based differences in stroke risk factors and outcomes from Pakistan.

METHODS

We enrolled 231 consecutive patients diagnosed with acute stroke. All patients received care along a standardized stroke pathway in a single stroke unit. We analyzed demographic and medical factors, NIHSS scores, and outcomes.

RESULTS

Of 213 consecutive hospitalized patients, 135 patients were men and 76 were women. The male to female ratio was 1.84. The mean age of males was 62.3±13.56, as compared to females 61.15±11.60 years. Hypertension, smoking, and dyslipidemia were more commonly found in men whereas ischemic heart disease, atrial fibrillation, and history of prior stroke were more frequently encountered in women. However, after adjustment for age and gender smoking in men (P=.059) and atrial fibrillation (P=.054) and prior stroke (P=.017) in women, these were found to be independent predictors of stroke. Diabetes was equally distributed between the two genders. Women were more likely to be dependent prestroke (P=.524), have more severe strokes (P=.142), and more likely to have a longer hospital stay (P=.942). In-hospital mortality was higher in women than in men (6.7% vs 5%; P=.524) and they had poorer discharge modified Rankin Scale scores (mRS 5; 8.5% vs 5%; P=.775); however, these differences were not statistically significant.

CONCLUSION

There appear to be gender-based differences in the risk factor profile and perhaps outcome in Pakistani patients despite standardized care in a dedicated stroke unit.

Keywords

Gender, stroke, Pakistan, stroke units