Sex Differences in Participation Restriction in Social Activities Among Older Stroke Survivors: A Nationwide Study

BACKGROUND: Women experience more poststroke physical activity limitations, but sex differences in social activity participation, an important patient-reported outcome for stroke recovery, remain uncertain. METHODS: Incident stroke survivors aged ≥65 years were identified from the US NHATS (National Health and Aging Trends Study), 2011-2022. Participants were asked to report restricted participation in the past month in 2 formal activities (religious services and clubs/classes) and 2 informal activities (visiting friends/family and going out for enjoyment) in the year of stroke onset. Logistic regression was used to assess sex differences in any participation restrictions across the 4 activities and within each activity, without and with adjustment for potential confounders, including sociodemographic, social-environmental, technological- and service environmental, psychological, health condition–related factors, and activity limitations. RESULTS: Among stroke survivors (N=469; 56.6% women; 50.4% of 75–84 years of age), women were more likely to be older, widowed, live alone, not currently driving, have worse physical capacity, and have more activity limitations. Women had a higher unadjusted prevalence of any participation restriction (40.3% versus 29.4%; odds ratio, 1.90 [95% CI, 1.21–2.99]) and restriction in attending religious services (27.5% versus 19.0%; odds ratio, 1.80 [95% CI, 1.08–3.02]). These sex differences were attenuated most after individual adjustment for physical capacity, marital status, and driving mobility, followed by adjustment for comorbidities, living alone, and activity limitations. No significant sex differences were found after simultaneously adjusting for these factors (adjusted odds ratio, 1.36 [95% CI, 0.70–2.65] for any participation restrictions; adjusted odds ratio, 1.36 [95% CI, 0.74–2.49] for restrictions in religious service attendance). CONCLUSIONS: Social participation restrictions are prevalent among older stroke survivors, particularly for women, which appears to be attributable to sex differences in social factors and prestroke health. Future interventions targeting vulnerable subgroups, including socially isolated women and women with poorer health, should be considered.