Sex Differences in Patients with Stroke: A Hospital-Based Multicenter Prospective Study in Brazil

Introduction: Stroke in Brazil disproportionately affects women, despite men having higher age-adjusted incidence and mortality rates. Women’s longer lifespan contributes to their increased stroke burden, particularly among older individuals. Objective: This study examines sex disparities in stroke epidemiology and treatment in Fortaleza, Brazil, addressing the lack of sex-specific stroke data. Methods: Data were prospectively collected from 19 hospitals between April 2009 and April 2012, following the WHO's Stroke Steps program, with analysis stratified by sex assigned at birth. Results: Out of 4,679 patients, 2,403 were females. Women were significantly older than men (69.1 years vs. 66.2 years, p < 0.01). Time to hospital admission and CT scans from symptom onset were similar between sexes. Men typically presented with motor, speech, and sensory symptoms, while women more often experienced decreased consciousness and headaches. Women had higher rates of diabetes and obesity, whereas men were more likely to smoke and have a history of alcohol abuse, myocardial infarctions, or strokes. Univariable logistic regressions examined factors affecting the modified Rankin Scale (mRS) scores at discharge, categorizing scores into 0-2 (lesser disability) and 3-6 (greater disability). Fewer women achieved an mRS score of ≤2 compared to men (77.6% vs. 81.7%, p < 0.01). Multivariable analysis indicated that being female increased the likelihood of a higher mRS score at discharge (OR 1.23, 95% CI [1.01-1.51], p = 0.04). Conclusion: The study highlights the persistent challenge for women in regaining independence post-stroke, emphasizing the need for personalized stroke care that addresses sex-specific differences.