# Biological sex-dependent differences in acute and post-acute stroke care—a population-based case–control study

## TL;DR

This study examines differences in stroke care between men and women, finding few disparities in treatment but notable differences in diagnostics and outcomes.

## Contribution

A comprehensive population-based analysis of sex-dependent differences across the entire stroke care pathway.

## Key findings

- Women were less likely to be admitted to stroke units and undergo MRI or echocardiography.
- Women had fewer serious post-stroke complications, while men had higher mortality and re-admission rates.
- Adjusting for age and stroke severity showed minimal disparities in most care aspects.

## Abstract

Observed disparities in stroke care between the biological sexes are based on observational data from stroke centres or focus on single aspects of stroke care. Hence, we offer a comprehensive analysis encapsulating the entire stroke treatment path.

The quality-controlled, population-based Tyrolean Stroke Care pathway, recording all ischemic stroke cases in the entire federal state independent of treating hospital or department, was applied. Data from all patients (2019-2023) were analysed, which encompass information from stroke call activation to the time of recurrent stroke associated re-hospitalisation.

5733 ischemic stroke cases (men/women 56.0%/44.0%) were recorded with an incidence of first ever stroke of 133/100,000 inhabitants. Men were numerically more likely to suffer a stroke during that time period (149 vs 118/100,000 respectively). After adjusting for age, National Institute of Stroke Scale, and the pre-stroke modified Rankin Scale, no differences in pre-hospital stroke care, post-stroke rehabilitation access as well as most in-hospital metrics were seen. Still, women were less likely to be admitted to stroke units (odds ratio [OR] 0.89 [0.80, 1.00]) and less frequently underwent MRI (OR 0.85 [0.74, 0.96]) or echocardiography (OR 0.85 [0.76, 0.96]) during their hospital stay. However, women less frequently suffered serious post-stroke in-house complications (OR 0.80 [0.66, 0.97]). Upon follow-up, men had higher rates of all cause-mortality (OR 0.81 [0.69, 0.94]) as well as recurrent stroke-related re-admission (OR 0.63 [0.48, 0.83]).

Within a highly structured and quality-controlled stroke care pathway, disparities in stroke care between sexes are low. Differences exist in terms of diagnostic algorithms, post-stroke mortality and recurrent stroke-related re-admissions, which merit further research.

Graphical abstract