Sex, gender, and stroke recovery: Functional limitations and inpatient care needs in Canadian and European survivors

Background: Stroke is a leading cause of long-term disability among survivors. Past literature already investigated the biological sex differences in stroke outcome; still limited work on gender differences is published. Therefore, the study aimed at investigating whether biological sex and sociocultural gender of survivors play a role as determinants of disability and quality of life among stroke survivors across Europe and Canada. Methods: Data were gathered from the European Health Information Survey (EHIS, n = 316,333) and Canadian Community Health Survey (CCHS, n = 127,462) data sets. Main outcomes of interest were disability, assessed through evaluating the impairment of Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (iADL), and inpatient care needs, such as hospitalization or institutionalization. Multivariate logistic regression models were utilized to identify factors independently associated with outcomes. Federated analysis was conducted for cross-country comparisons. Data were adjusted for the country-specific Gender Inequality Index (GII), with higher score corresponding to more gender inequality toward females. Results: Female survivors showed greater impairments in iADL (odds ratio [OR] = 1.73, 95% confidence interval [CI]:1.53–1.96) and ADL (OR = 1.25, 95% CI: 1.09–1.44), without a corresponding increase in inpatient care needs. Socioeconomic factors such as marital status and income level were significant predictors of disability, with low income and being single/divorced associated with higher risks. The impact of sex was more pronounced in countries with higher GII, indicating the influence of gender inequality on stroke outcomes. Interpretation: The findings highlight the significant impact of biological sex and gender-related social determinants on post stroke disability, with female sex and unfavorable socioeconomic conditions being associated with worse outcomes.