Platform Presentation The Joint Annual Meeting of the Stroke Society of Australasia (SSA) and Smartstrokes 2023

Sex-differences in Acute Stroke In-hospital Mortality in Chile: Data from a Multicenter Nationwide Hospital-Based Registry (#13)

Maria Ignacia Allende 1 , Marilaura Nuñez 1 , Francisca Gonzalez 1 , Paula Muñoz-Venturelli 1 2 3
  1. Centro de Estudios Clínicos, Facultad de Medicina Universidad del Desarrollo, Santiago, Chile
  2. Departamento Neurología y Psiquiatría, Facultad de Medicina Clinica Alemana Universidad del Desarrollo, Santiago , Chile
  3. The George institute for Global Health , Faculty of Medicine University of New South Wales, Sydney , New South Wales , Australia

Background: Understanding sex-differences in stroke outcomes is important for improving stroke care and reducing the global burden of stroke. Sex-differences in stroke mortality in Chile have been poorly reported.

Aims: Investigate sex-differences in acute stroke in-hospital mortality (IHM) during 2019, using a nationwide database from Chile.

Methods: A retrospective analysis was conducted on the Chilean Diagnosis Related Group (DRG), which included information on all discharges from 65 hospitals across the country between January 1st  and December 31st, 2019. Acute stroke was defined as main diagnosis with corresponding ICD-10 codification (I60, I61, I62, I63, I64). Severity of stroke was not included in the analysis due to limited data availability. Multiple logistic regression was performed to analyse the association between sex and IHM, adjusting for available potential confounders. Data were analysed with STATA v17.1.

Results: Among 1,048,575 hospital events registered in the DRG, we identified 15,535 stroke patients, of whom 7,074 (45.5%) were women and 2,438 patients (15.6%) were reported dead during hospitalization. Between all stroke patients, 67.2% corresponded to ischemic stroke (4,659/10,440[44.6%] women), 23.6% to intracerebral hemorrhage (ICH, 1,568/3,680[42.6%] women) and 6.7% to subarachnoid hemorrhage (675/1,049[64.3%] women). Compared to men, women were found to be older (70.36±14.76 versus 67.03±13.45, P<0.001) and belong to a lower socioeconomic status (81.75% versus 68.56%, P<0.001). After adjusting for covariates, IHM in all stroke  was independently associated with sex (women [OR=1.10;95%CI:1.01-1.21]), older people (≥65years [OR=1.35;95%CI:1.22-1.49]), lowest socioeconomic status ([OR=1.14;95%CI:1.00-1.31]), admission to a hospital without stroke care unit ([OR=1.26;95%CI:1.15-1.39]) and complications during hospitalization ([OR=3.14;95%CI:2.87-3.44]). Regarding sex-differences by stroke subtype, only ICH showed statistically significant association (women OR=1.22, 95%CI 1.06-1.41).

Conclusion: Sex-differences in mortality rates after acute stroke vary according to stroke type. Further research can provide new insights into additional factors that contribute to sex-differences in stroke mortality.