Sex differences in etiologies, risk factors, and outcomes among young adult patients with acute ischemic stroke

IF 2 4区医学 Q3 NEUROSCIENCES

Journal of Stroke & Cerebrovascular Diseases Pub Date : 2025-06-16 DOI:10.1016/j.jstrokecerebrovasdis.2025.108380

Ekta G. Shah DO, MS , Manish Bhojwani MD, MPH , Kelly Chang MD , Deepa Dongarwar BS , Nicole R. Gonzales MD , Erica Jones MD , Audrey Sarah Cohen MS , Anjail Z. Sharrief MD, MPH

{"title":"Sex differences in etiologies, risk factors, and outcomes among young adult patients with acute ischemic stroke","authors":"Ekta G. Shah DO, MS , Manish Bhojwani MD, MPH , Kelly Chang MD , Deepa Dongarwar BS , Nicole R. Gonzales MD , Erica Jones MD , Audrey Sarah Cohen MS , Anjail Z. Sharrief MD, MPH","doi":"10.1016/j.jstrokecerebrovasdis.2025.108380","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>The incidence of ischemic stroke is increasing among young adults. Several studies have demonstrated sex differences in risk and outcomes; however, findings are inconsistent. We sought to evaluate sex differences in stroke risk factors, etiology, and disposition in a diverse cohort of patients admitted to a comprehensive stroke center for evaluation.</div></div><div><h3>Methods</h3><div>We conducted a retrospective study of patients 18-45 years admitted between January 1, 2015 and September 30, 2021 with an acute ischemic stroke. Patient demographics, risk factors, and disposition were extracted from our institutional inpatient stroke registry and inpatient electronic medical record. Stroke etiology was assigned based on record review. Bivariate analyses were conducted between sex and demographic variables, risk factors, stroke etiology, and disposition.</div></div><div><h3>Results</h3><div>Among 785 patients included, 48.9% (n=384) were female and 51.1% (n=401) were male. Female patients had a higher proportion of prior strokes, cardiac/pulmonary shunts, autoimmune disorders, history of migraine headaches, and exogenous hormone use with a higher proportion of ischemic strokes of other etiologies. Male patients had a higher proportion of lower left ventricular ejection fraction, atrial fibrillation, substance use, and obstructive sleep apnea with a higher proportion of ischemic strokes due to small vessel occlusions and cardioembolic sources. There was a comparable proportion of traditional risk factors and strokes secondary to large artery atherosclerosis between the sexes. No sex differences were seen among functional outcomes at discharge; however, female patients had a lower inpatient mortality rate and lower odds of being discharged to skilled nursing facilities/long-term acute care hospitals/acute care facilities compared to male patients.</div></div><div><h3>Conclusions</h3><div>This study supports the known sex differences in stroke risk factors, etiology, and outcomes for ischemic stroke in young patients, showing the relationship also remains applicable in a large, diverse population. Strategies to address these differences could improve stroke classification and stroke prevention efforts, improving outcomes in this age group.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 8","pages":"Article 108380"},"PeriodicalIF":2.0000,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Stroke & Cerebrovascular Diseases","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1052305725001582","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"NEUROSCIENCES","Score":null,"Total":0}

引用次数: 0

Abstract

Background

The incidence of ischemic stroke is increasing among young adults. Several studies have demonstrated sex differences in risk and outcomes; however, findings are inconsistent. We sought to evaluate sex differences in stroke risk factors, etiology, and disposition in a diverse cohort of patients admitted to a comprehensive stroke center for evaluation.

Methods

We conducted a retrospective study of patients 18-45 years admitted between January 1, 2015 and September 30, 2021 with an acute ischemic stroke. Patient demographics, risk factors, and disposition were extracted from our institutional inpatient stroke registry and inpatient electronic medical record. Stroke etiology was assigned based on record review. Bivariate analyses were conducted between sex and demographic variables, risk factors, stroke etiology, and disposition.

Results

Among 785 patients included, 48.9% (n=384) were female and 51.1% (n=401) were male. Female patients had a higher proportion of prior strokes, cardiac/pulmonary shunts, autoimmune disorders, history of migraine headaches, and exogenous hormone use with a higher proportion of ischemic strokes of other etiologies. Male patients had a higher proportion of lower left ventricular ejection fraction, atrial fibrillation, substance use, and obstructive sleep apnea with a higher proportion of ischemic strokes due to small vessel occlusions and cardioembolic sources. There was a comparable proportion of traditional risk factors and strokes secondary to large artery atherosclerosis between the sexes. No sex differences were seen among functional outcomes at discharge; however, female patients had a lower inpatient mortality rate and lower odds of being discharged to skilled nursing facilities/long-term acute care hospitals/acute care facilities compared to male patients.

Conclusions

This study supports the known sex differences in stroke risk factors, etiology, and outcomes for ischemic stroke in young patients, showing the relationship also remains applicable in a large, diverse population. Strategies to address these differences could improve stroke classification and stroke prevention efforts, improving outcomes in this age group.

查看原文本刊更多论文

青年急性缺血性脑卒中患者的病因、危险因素和预后的性别差异

背景缺血性脑卒中在年轻人中的发病率正在上升。一些研究已经证明了风险和结果的性别差异；然而，研究结果并不一致。我们试图在一个综合性卒中中心评估的不同队列患者中评估卒中危险因素、病因和处置的性别差异。方法对2015年1月1日至2021年9月30日收治的18-45岁急性缺血性脑卒中患者进行回顾性研究。患者人口统计资料、危险因素和处置情况从我们的机构住院卒中登记和住院电子病历中提取。卒中病因是基于记录的回顾。在性别和人口统计学变量、危险因素、中风病因和性格之间进行双变量分析。结果785例患者中，女性384例（48.9%），男性401例（51.1%）。女性患者既往卒中、心/肺分流、自身免疫性疾病、偏头痛史和外源性激素使用的比例较高，其他病因缺血性卒中的比例较高。男性患者左室射血分数较低、心房颤动、药物使用、阻塞性睡眠呼吸暂停比例较高，小血管闭塞、心栓子源缺血性卒中比例较高。传统危险因素和继发于大动脉粥样硬化的中风在两性之间的比例相当。出院时的功能结局无性别差异；然而，与男性患者相比，女性患者的住院死亡率较低，出院到专业护理机构/长期急症护理医院/急症护理机构的几率较低。结论：本研究支持已知的年轻缺血性卒中患者卒中危险因素、病因和结局的性别差异，表明这种关系也适用于大量不同的人群。解决这些差异的策略可以改善卒中分类和卒中预防工作，改善该年龄组的预后。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Journal of Stroke & Cerebrovascular Diseases Medicine-Surgery

CiteScore

5.00

自引率

4.00%

发文量

583

审稿时长

62 days

期刊介绍： The Journal of Stroke & Cerebrovascular Diseases publishes original papers on basic and clinical science related to the fields of stroke and cerebrovascular diseases. The Journal also features review articles, controversies, methods and technical notes, selected case reports and other original articles of special nature. Its editorial mission is to focus on prevention and repair of cerebrovascular disease. Clinical papers emphasize medical and surgical aspects of stroke, clinical trials and design, epidemiology, stroke care delivery systems and outcomes, imaging sciences and rehabilitation of stroke. The Journal will be of special interest to specialists involved in caring for patients with cerebrovascular disease, including neurologists, neurosurgeons and cardiologists.