Gender differences in acute ischemic stroke care: Results from the Massachusetts Paul Coverdell National Acute Stroke Registry

Background – Since 2004, the Massachusetts Department of Public Health (MDPH) has been funded through the Centers for Disease Control and Prevention to implement the Paul Coverdell National Acute Stroke Registry (Coverdell Registry) and quality improvement initiative. Currently 55 hospitals participate in the Coverdell Registry through data collection and clinical quality improvement activities.

Methods – From June 2005 through January 2008, 12,037 acute ischemic stroke cases have been captured in the MA Coverdell Stroke Registry. Using these data, we assessed gender differences in nine acute stroke care performance measures recognized nationally by the Centers for Disease Control and Prevention, the American Stroke Association, and the Joint Commission.

Results – Of the 12,037 acute ischemic stroke cases, 47.15% were male. Men with acute ischemic strokes were more likely to be younger (ages 45-64) (OR = 2.19, 95% CI 2.00 to 2.40), have been independently ambulating prior to their stroke (OR = 2.13, 95% CI 1.77 to 2.55), and have less severe strokes (National Institutes of Health Stroke Scale value of 0-2) (OR = 1.24, 95% CI 1.09 to 1.40) than women. Men were less likely than women to be on Medicare or Medicaid insurance (OR = 0.56, 95% CI 0.52 to 0.60) or arrive to the Emergency Department via Emergency Medical Services (OR = 0.68, 95% CI 0.63 to 0.73). In a bivariate analysis of the nine performance measures, several significant differences were seen with regards to gender. However, when we assessed each performance measure for gender differences using backwards stepwise logistic regression modeling while controlling for age, stroke severity, prior ambulation status, mode of arrival to the Emergency Department, and insurance type, most of the gender differences were no longer significant. Of the nine performance measures assessed, only the association between male gender and being discharged on antithrombotics was maintained (OR = 1.80, 95% CI 1.03 to 3.17).

Conclusion – Among 55 Massachusetts hospitals participating in the Coverdell Registry, gender does not play a significant role in predicting which stroke patients receive appropriate care. A single gender-related disparity in acute stroke care was observed in prescribing practices of antithrombotics at discharge where men have greater odds of receiving the appropriate treatment than women.