Sex Differences in Young Adult Stroke Severity Using Linked Colorado-All Payer's Claims Database and the Get With The Guidelines-Stroke Registry.

BACKGROUND

More young women than men experience first-time strokes. This may be from improved detection of milder severity strokes in young women, as they are more likely to present with nondebilitating neurologic symptoms than men.

METHODS

The objective was to examine sex differences in stroke severity among young adults. Young adults (18-55) with index stroke (January 1, 2012-April 3, 2019) were identified, using Colorado All Payer's Claims Database and linked to the GWTG (Get With The Guidelines)-Stroke Registry. Records were reviewed based on 5/5 linked identifiers (±1 day for admission/discharge dates, date of birth, sex, and hospital), then on 4/5 linked identifiers. Stroke severity based on National Institutes of Health Stroke Scale score was extracted from GWTG-stroke. Logistic regression models were used to calculate odds ratios (OR) of having a mild severity stroke (National Institutes of Health Stroke Scale score ≤5) by sex in ages 18 to 45 and 46 to 55 years.

RESULTS

Colorado All Payer's Claims Database captured 3029 stroke cases; 2732 from hospitals that reported to GWTG-Stroke; 1597 (58.7%) linked at least 4/5 identifiers; 1311 with National Institutes of Health Stroke Scale score (50.2% women, 80% ischemic). Women were younger (mean age 45.4 years, men 46.9 years, P=0.001), had lower blood pressure (median 143/85, men 150/91, P<0.001), and lower proportion without nontraditional risk factors (16.7%, men 29.0%, P<0.001). No sex differences in stroke severity were observed for all strokes (OR 18-45, 1.10 [95% CI, 0.74-1.61]; OR, 46-55, 0.80 [95% CI, 0.59-1.09]). Women aged 18 to 45 years experienced more mild severity hemorrhagic strokes (OR, 2.94 [95% CI, 1.18-7.69], P=0.02) but not in 46-55 (OR, 1.02 [95% CI, 0.5-2.08]). There was no difference in ischemic stroke severity by sex in either age group.

CONCLUSIONS

Young women with index strokes did not present with more milder severity strokes compared with men.