Sex Disparity in Stroke Quality of Care in a Community-Based Study

Background Studies have suggested that women may receive lower stroke quality of care (QOC) than men, although population-based studies at nonacademic centers are limited. We investigated sex disparities in stroke QOC in the Brain Attack Surveillance in Corpus Christi Project. Methods All ischemic s...

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Bibliographic Details
Published in:Journal of stroke and cerebrovascular diseases 2017-08, Vol.26 (8), p.1781-1786
Main Authors: McDermott, Mollie, MD, Lisabeth, Lynda D., PHD, Baek, Jonggyu, PHD, Adelman, Eric E., MD, Garcia, Nelda M., BS, Case, Erin, BA, Campbell, Morgan S., MD, Morgenstern, Lewis B., MD, Zahuranec, Darin B., MD, MS
Format: Article
Language:English
Subjects:
Aged
Aged, 80 and over
Brain Ischemia - diagnosis
Brain Ischemia - physiopathology
Brain Ischemia - therapy
Cardiovascular
Community Health Services - standards
Female
Fibrinolytic Agents - administration & dosage
gender
Guideline Adherence - standards
Healthcare Disparities - standards
Humans
Ischemic stroke
Male
Middle Aged
Neurology
Odds Ratio
Patient Discharge - standards
Practice Guidelines as Topic - standards
Practice Patterns, Physicians' - standards
Process Assessment, Health Care - standards
Prospective Studies
quality
Quality Indicators, Health Care - standards
Risk Assessment
Risk Factors
Sex Factors
Stroke - diagnosis
Stroke - physiopathology
Stroke - therapy
Texas
Treatment Outcome
Venous Thrombosis - prevention & control
women
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Summary:Background Studies have suggested that women may receive lower stroke quality of care (QOC) than men, although population-based studies at nonacademic centers are limited. We investigated sex disparities in stroke QOC in the Brain Attack Surveillance in Corpus Christi Project. Methods All ischemic stroke patients admitted to 1 of 6 Nueces County nonacademic hospitals between February 2009 and June 2012 were prospectively identified. Data regarding compliance with 7 performance measures (PMs) were extracted from the medical records. Two overall quality metrics were calculated: a composite score of QOC representing the number of achieved PMs over all patient-appropriate PMs, and a binary measure of defect-free care. Multivariable models with generalized estimating equations assessed the association between sex and individual PMs and between sex and overall quality metrics. Results A total of 757 patients (51.6% female) were included in our analysis. After adjustment, women were less likely to receive deep vein thrombosis prophylaxis at 48 hours (relative risk [RR] = .945; 95% CI, .896-.996), an antithrombotic by 48 hours (RR = .952; 95% CI, .939-.965), and to be discharged on an antithrombotic (RR = .953; 95% CI, .925-.982). Women had a lower composite score (mean difference −.030, 95% CI −.057 to −.003) and were less likely to receive defect-free care than men (RR = .914; 95% CI, .843-.991). Conclusions Women had lower overall stroke QOC than men, although absolute differences in most individual PMs were small. Further investigation into the factors contributing to the sex disparity in guideline-concordant stroke care should be pursued.
ISSN:1052-3057
1532-8511
DOI:10.1016/j.jstrokecerebrovasdis.2017.04.006