Factors contributing to sex differences in functional outcomes and participation after stroke.

Objective To examine factors contributing to the sex differences in functional outcomes and participation restriction after stroke. Methods Individual participant data on long-term functional outcome or participation restriction (i.e., handicap) were obtained from 11 stroke incidence studies (1993–2014). Multivariable log-binomial regression was used to estimate the female:male relative risk (RR) of poor functional outcome (modified Rankin Scale score >2 or Barthel Index score Results In unadjusted analyses, women experienced worse functional outcomes after stroke than men (1 year: pooled RR unadjusted 1.32, 95% confidence interval [CI] 1.18–1.48; 5 years: RR unadjusted 1.31, 95% CI 1.16–1.47). However, this difference was greatly attenuated after adjustment for age, prestroke dependency, and stroke severity (1 year: RR adjusted 1.08, 95% CI 0.97–1.20; 5 years: RR adjusted 1.05, 95% CI 0.94–1.18). Women also had greater participation restriction than men (pooled MD unadjusted −5.55, 95% CI −8.47 to −2.63), but this difference was again attenuated after adjustment for the aforementioned factors (MD adjusted −2.48, 95% CI −4.99 to 0.03). Conclusions Worse outcomes after stroke among women were explained mostly by age, stroke severity, and prestroke dependency, suggesting these potential targets to improve the outcomes after stroke in women.