Sex differences in stroke: epidemiology, clinical presentation, medical care, and outcomes
Open accessAbstract
Stroke has a greater effect on women than men because women have more events and are less likely to recover. Age-specific stroke rates are higher in men, but, because of their longer life expectancy and much higher incidence at older ages, women have more stroke events than men. With the exception of subarachnoid haemorrhage, there is little evidence of sex differences in stroke subtype or severity. Although several reports found that women are less likely to receive some in-hospital interventions, most differences disappear after age and comorbidities are accounted for. However, sex disparities persist in the use of thrombolytic treatment (with alteplase) and lipid testing. Functional outcomes and quality of life after stroke are consistently poorer in women, despite adjustment for baseline differences in age, prestroke function, and comorbidities. Here, we comprehensively review the epidemiology, clinical presentation, medical care, and outcomes of stroke in women.
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Women in North America carry a larger stroke burden than men, including higher lifetime stroke risk, higher lifetime stroke death risk, and worse post-stroke outcomes.
“In North America, women bear a greater burden of disease due to a higher lifetime risk of stroke,1 a higher lifetime risk of death from stroke, and a higher risk of poor outcomes following stroke compared with men.2–4”
From Sex Differences in Physical Activity and Incident Stroke: A Systematic Review (2022) · cites this paper as [2]
The Mortality section reports more total stroke deaths among women in the USA, and Functional outcomes and quality of life reports consistently poorer post-stroke outcomes for women, including in North American studies. The paper does not establish a higher lifetime risk of dying from stroke; it reports lower age-adjusted stroke mortality rates for women and substantial variation by age. The sentence cites a different source for lifetime stroke risk. (LLM, conf=0.86)
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Heart Disease and Stroke Statistics—2017 Update: A Report From the American Heart Association
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Self-citationHeart Disease and Stroke Statistics—2020 Update: A Report From the American Heart Association
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Self-citationHeart Disease and Stroke Statistics—2015 Update: A Report From the American Heart Association
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Self-citationHeart Disease and Stroke Statistics—2014 Update
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Self-citationHeart Disease and Stroke Statistics—2013 Update: A Report From the American Heart Association
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Self-citationForecasting the Future of Stroke in the United States
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Stroke Epidemiology and Risk Factor Management
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Self-citationThe Impact of Sex and Gender on Stroke
Rexrode, K. M., Madsen, T. E., Yu, A., Carcel, C., Lichtman, J. H., & Miller, E. C. (2022) · Circulation Research · doi:10.1161/circresaha.121.319915 · Cited by 609 · see citing works
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Functional and Motor Outcome 5 Years After Stroke Is Equivalent to Outcome at 2 Months
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Gene Expression in Peripheral Immune Cells following Cardioembolic Stroke Is Sexually Dimorphic
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Sex Differences in Long-Term Outcomes After Stroke
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“We conducted 3 sensitivity analyses: (1) we included a variable for proxy use in our final model; (2) we reran the final model considering ADL and IADL subscales as separate outcomes; (3) we considered the effect of loss to follow-up by modeling the probability of missing outcome as dependent on the outcome itself.”
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- Authors
- Reeves, M. J., Bushnell, C. D., Howard, G., Gargano, J. W., Duncan, P. W., Lynch, G., Khatiwoda, A., & Lisabeth, L.
- Affiliations
- Michigan State University (US)
- Wake Forest University Health Sciences (US)
- University of Birmingham (GB)
- Duke University (US)
- Case Western Reserve University (US)
- University of Michigan (US)
- Corresponding author
- Reeves, Mathew J
- ORCID
- Venue
- The Lancet Neurology
- Publisher
- Elsevier BV
- Published
- 2008-10
- Volume
- 7
- Issue
- 10
- Pages
- 915-926
- ISSN
- 1474-4422 (ISSN-L)
- PMC
- PMC2665267
- OpenAlex
- W2152601292
- Cited by
- 1,362
- References
- 147
- Citations by year
- 2026: 72 · 2025: 84 · 2024: 121 · 2023: 106 · 2022: 121 · 2021: 114 · 2020: 106 · 2019: 88 · 2018: 73 · 2017: 75 · 2016: 67 · 2015: 63 · 2014: 61 · 2013: 47 · 2012: 41
- FWCI
- 4.25
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Licence
- Locations
- The Lancet Neurology (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Michigan State University
- National Institutes of Health (5k02ns058760-04)
- National Institute of Neurological Disorders and Stroke (K02-NS058760)
- Topics
- Health Sciences › Medicine › Epidemiology › Acute Ischemic Stroke Management
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Sex and Gender in Healthcare
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Cerebrovascular and Carotid Artery Diseases
- Keywords
- sex differences, stroke, women, stroke epidemiology, stroke care disparities, thrombolysis, alteplase, lipid testing, functional outcome, quality of life, stroke recovery, subarachnoid hemorrhage
- MeSH terms
- Female, Humans, Male, Sex Characteristics, Stroke
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