Sex differences in stroke recovery and stroke-specific quality of life - Results from a statewide stroke registry

Background and Purpose - Little is known about sex differences in stroke recovery. The few available studies have found that female stroke survivors are less likely to achieve independence in activities of daily living and have poorer quality of life than male survivors. Methods - A total of 373 acute stroke survivors discharged from 9 hospitals participating in a statewide stroke registry were prospectively enrolled in an outcomes study. Follow-up data, including the Barthel Index and Stroke-Specific Quality of Life, were obtained from the survivor or a proxy by telephone interview 90 days postdischarge. The independent effects of sex on activities of daily living independence (Barthel Index >= 95) and Stroke-Specific Quality of Life scores, controlling for age, race, subtype, prestroke ambulatory status, and other patient characteristics, were determined using adjusted odds ratios and least-squares means, respectively. Results - Twenty-five percent of the patients required a proxy respondent. In adjusted models, females were less likely to achieve activities of daily living independence (adjusted OR: 0.37, 95% CI: 0.19 to 0.87). Females had lower least-squares means Stroke-Specific Quality of Life scores in Physical Function (3.9 versus 4.2, P = 0.02), Thinking (2.8 versus 3.4, P < 0.001), Language (4.3 versus 4.5, P = 0.03), and Energy (2.6 versus 3.0, P < 0.01). Interactions between sex and prior stroke were found for Mood, Role Function, and Summary Score, resulting in lower least-squares means for females only among subjects without prior stroke. Conclusions - Compared with males, female stroke survivors had lower functional recovery and poorer quality of life 3 months postdischarge. These differences were not explained by females' greater age at stroke onset or other demographic or clinical characteristics.