Gender gap in stroke treatment narrowing

Previous studies have shown that men are more likely than women to receive treatment with IV thrombolysis for acute ischemic stroke. However, new research published in Neurology, the medical journal of the American Academy of Neurology, suggests the treatment gap appears to be narrowing.

“Thrombolysis is the most effective treatment we have to prevent the potentially life altering disability that can occur following a stroke,” Mathew Reeves, PhD, professor of epidemiology and biostatistics at Michigan State University in East Lansing, told Healio Primary Care. “Any treatment gap found for women is to their detriment.”

In 2009, a meta-analysis of 18 studies showed that women had 30% lower odds of receiving IV recombinant tissue plasminogen activator (rtPA) for acute ischemic stroke compared with men.

“Over the life course more women than men suffer a stroke, women are older when they have their stroke and have greater disability afterwards,” Reeves said. “Thrombolysis can help reduce these higher rates of disability in women ... if they receive it.”

To determine if the treatment gap persisted in recent years, Reeves and colleagues conducted a systematic review and meta-analysis of 24 studies with sex-specific information on IV rtPA treatment for acute ischemic stroke published from 2008 through 2018. Of those, 17 studies included treatment rates for all patients with acute ischemic stroke.

The results showed that women had 13% lower odds of receiving IV rtPA treatment than men (OR = 0.87; 95% CI, 0.82-0.93), according to Reeves and colleagues. However, the researchers noted that there was substantial variability between the studies.

An analysis of seven studies that included data on a subgroup of patients who were eligible for IV rtPA also found lower odds for women receiving treatment (summary OR = 0.95; 95% CI, 0.88-1.02), although this was not statistically significant.

To estimate the treatment gap over time, the researchers developed a time trend using the 17 studies with data on all patients with acute ischemic stroke and 16 studies from the 2009 meta-analysis. The researchers categorized these 33 studies into four time periods based on publication date and found that the linear trend across the summary ORs was not statistically significant.

However, when directly comparing summary ORs, Reeves and colleagues determined that women’s odds of receiving treatment was significantly different between 2000 to 2004 (OR = 0.73; 95% CI, 0.67-0.8) and 2014 to 2018 (OR = 0.9; 95% CI, 0.84-0.97).

“We need to continue to monitor and study this treatment gap, as well as others,” Reeves said.

He noted that in addition to increasing public education on stroke, efforts are needed to “redesign stroke systems of care to improve the identification, transportation, work-up and treatment of stroke while continuing to closely exam treatment rates in women.”

“We want to see thrombolysis treatment rates increase for everyone — men and women,” Reeves said. “Right now, treatment rates are still too low.”

References:

American Academy of Neurology. Treatment gap between men and women for stroke may have narrowed. https://www.aan.com/PressRoom/Home/PressRelease/3799. Accessed June 10, 2020.

Reeves M, et al. Neurology. 2020;doi:10.1212/WNL.0000000000009733.