Gender disparity in the access of elderly patients to acute stroke care

Background: Gender differences in management of acute coronary symptoms are well documented. This study was performed to determine whether similar gender disparities exist in acute stroke, in particular with regard to early hospital admission and thrombolytic therapy.

Methods: We analysed a large prospective hospital-based stroke registry with more than 100 hospitals enrolling stroke patients into this computerized database. Within a 7-year period (1999–2005), all cases with a final diagnosis of cerebral infarction (ICD-10: I63) or intracerebral hemorrage (ICD-10: I61) were selected. Datasets with missing values for gender and time to admission as well as datasets from patients transferred between hospitals in the acute phase were excluded. Main outcome measures were the probability of being admitted within the first three hours after stroke onset and being treated with thrombolytic agents for both females and males.

Results: 53414 patients were included (49% female, age 72±12 years). After multivariate adjustment (age, severity of clinical symptoms, risk factors, pre-hospital status, type of stroke), women had a 10% lesser chance to be admitted within the first three hours then males (OR 0.902, p<0.001). Compared to men, the probability of early admittance decreased for women with increasing age. Additionally, the chance to be treated with thrombolysis was 13% lower for females than for males (OR 0.867, 95%CI 0.782–0.960, p=0.006). However, for patients reaching the hospital within the three hour time window, the chance of being treated with thrombolysis was not significantly different for women and men (OR 0.915, p=0.156).

Conclusions: We identified gender disparities in acute stroke with regard to early hospital admission and thrombolytic treatment. This is best explained by the sociodemographic and geriatric fact that “surviving spouses“ are more likely to be women than men. Attempts to overcome disadvantages in their access to acute stroke care would have to focus on increased social support.