Gender Differences in Social Isolation and Self-reported Reasons for Calling 911 in Ischemic Stroke Patients: The SWIFT Study

Background:

Patients are often ineligible for acute stroke treatments because of delays between symptom onset and emergency department (ED) arrival.  While factors such as social isolation and perception of stroke symptoms have been shown to affect pre-hospital delays in stroke patients, the effect of gender on these associations is unknown.

Purpose:

Among a cohort of ischemic stroke/TIA patients, to investigate the effect of social isolation (living alone) on pre-hospital delays by gender and to examine gender differences in self-reported reasons for waiting to call 911.

Methods:

As part of the SWIFT (Stroke Warning Information and Faster Treatment) study, baseline data pertaining to patient demographics, social isolation, reasons for waiting to call 911, and time from symptom onset to emergency department (ED) arrival were collected from prospectively enrolled patients at Columbia University Medical Center with an initial diagnosis of stroke or TIA.  Logistic regression was conducted with arrival ≤3 hours as the outcome and social isolation as an explanatory variable; adjustments were made for relevant confounders. Interactions between gender and social isolation were tested for significance. Bivariate analyses were used to compare self-reported reasons for waiting to call 911 by gender among those with arrivals >3 hours.           

Results:

1193 participants were included; 50% were women, 17% were Black, and 51% were Latino. Women living alone were more likely to arrive in ≤3 hours compared to men living alone (aOR 2.3, 95%CI 1.16-4.53), but among those that lived with someone, women and men were equally likely to arrive in ≤3 hours (aOR 0.91, 95%CI 0.67-1.23). Women were more likely to endorse waiting for a family member (9.0% vs. 6.3%), not knowing what to do (9.0% vs. 6.3%), and “other” (39.2% vs. 35.3%) in response to stroke symptoms, while more men did not perceive the symptoms as serious (30.2% vs. 26.9%) and waited for symptoms to improve (16.3% vs. 11.5%) before calling 911 (p<0.05). 

Conclusions:

In the case of stroke symptoms, our data suggest that men benefit from the presence of a household member, while women do not. Further research should investigate how household gender roles impact pre-hospital delays in stroke.