Abstract
Background Knowledge of local contextual sex-differences in the profile and outcome for stroke can improve service delivery. We aimed to determine sex-differences in the profile of patients with acute stroke and their associations with in-hospital mortality (I-HM) in the national hospital database of Chile.
Methods We present a retrospective cohort based on the analysis of the 2019 Chilean database of Diagnosis-Related Groups (DRGs), which represents 70% of the operational expenditure of the public health system. Multiple logistic regression models were used to determine independent associations of acute stroke (defined by main diagnosis ICD-10 codes) and I-HM, and reported with odds ratios (OR) and 95% confidence intervals (CI).
Results Of 1,048,575 hospital discharges, 15,535 were for patients with acute stroke (7,074 [45.5%] in women) and 2,438 (15.6%) of them died in-hospital. Disparities by sex in sociodemographic and clinical characteristics were identified for stroke and main subtypes. Women with ischemic stroke had lower I-HM (OR 0.80, 95%CI 0.70-0.92; P=0.002) compared to men; other independent predictors included age (1.03, 1.03-1.04; P<0.001), chronic kidney disease (CKD) (1.48, 1.20-1.81; P<0.001), atrial fibrillation (1.56, 1.34-1.83; P<0.001), admission to hospital without a stroke unit (1.21, 1.05-1.39; P=0.003), and several risk factors. Conversely for intracerebral hemorrhage, women had higher I-HM than men (1.21, 1.04-1.41; P=0.02); other independent predictors included age (1.01, 1.00-1.01; P<0.001), CKD (1.54, 1.22-1.94; P<0.001), oral anticoagulant use (2.01, 1.56-2.59; P<0.001), and several risk factors.
Conclusion Sex disparities in patients characteristics and in-hospital mortality exist for acute stroke in Chile. I-HM is higher for acute ischemic stroke in men and higher for ICH in women. Future research is need to better identify contributing factors.
Competing Interest Statement
CSA reports research grants from the National Health and Medical Research Council (NHMRC) of Australia, the Medical Research Council (MRC) of the UK, and Takeda and Penumbra. PMV receives research grants from ANID Fondecyt Regular 1221837, Pfizer and Boehringer Ingelheim. PML reports research support from Clínica Alemana de Santiago and Boehringer Ingelheim, research grants from The George Institute and Clínica Alemana de Santiago, ANID Fondecyt and FONIS. Speakers' honoraria from Boehringer Ingelheim and Pfizer. Steering Committee honoraria from Bristol-Meyes-Squibb and Janssen and consulting honoraria from RAPID. The other authors declare no conflict of interest.
Funding Statement
No external funding was received
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Footnotes
↵* joint first authors
Data Availability
Data that support the findings of this study are available from the corresponding author upon reasonable request.