Sex Differences in Long-Term Outcomes After Stroke

There has been recent interest in sex differences in stroke with a focus on the first 3 months after stroke.1 We recently reported that females had more severe strokes, higher short-term mortality, and different management in comparison to males. This was explained by females' greater age and prevalence of comorbidities at stroke onset,2 findings supported by a recent review.3 Others have suggested that being female is a risk factor for poorer outcomes in the acute period independent of age and other covariates,1 raising the possibility of a sex bias in the diagnosis or treatment of stroke in females. Alternatively, biological differences between the sexes could influence outcome. For example, differences in muscle strength could explain worse functional outcomes in females.4Despite this recent interest, there has been little discussion of sex differences with regard to outcome in the longer term after stroke. This review addresses this gap, exploring sex differences in (1) functional outcomes, also known as “activity limitations” and historically as “disability”; (2) handicap, also known as “restriction of participation”; and (3) quality of life.We used a systematic search strategy to identify relevant literature. We searched PubMed, EBSCO/CINAHL, and Embase for full-text, English language articles published up to August 2011. All searches included the terms “stroke,” “cerebrovascular,” “cerebral infarction” OR “cerebral ischemia/ischemia” and “intracerebral hemorrhage/hemorrhage.” For full details of our search strategy, the online-only data supplement.The titles of articles identified were examined and studies not focused on stroke or assessing the relevant outcomes were excluded. Abstracts were examined, selecting studies that: (1) were hospital-based with consecutive ascertainment or population-based incidence studies; (2) reported functional outcome, handicap, or quality of life; (3) were conducted ≥12 months after stroke because most recovery will occur before this time5; and (4) reported results according …