College of

Treatment gap between men and women for stroke narrows

July 1, 2020

While studies in the early 2000s showed that women were 30% less likely to receive clot-busting treatment for a stroke than men, a new analysis of recent studies by a Michigan State University researcher found that the gap has narrowed to 13%, according to a meta-analysis published in Neurology®.

“We are heartened that this treatment gap has narrowed, but more research is definitely needed into why a gap persists and whether it is continuing to get smaller,” said Mathew Reeves, PhD, a College of Human Medicine professor of Epidemiology and Biostatistics and senior study author. “This is especially important as additional new treatments for acute stroke are developed and implemented.”

The earlier analysis looked at research studies of clot-busting treatment, also called thrombolysis, published from 2000 through 2008. For his study, published in the medical journal of the American Academy of Neurology, Reeves and colleagues analyzed 24 studies which included more than 1 million stroke patients.

Many studies found modest differences in the actual numbers of women receiving clot-busting treatments compared with men, he said.

“Most of the studies showed absolute difference of only 0.5% to 1.0% between treatment rates in men and women,” Reeves said. “The largest difference in one study was 8.4%.”

Still, even small differences could translate into many untreated women, given how common stroke is in the elderly population. These missed opportunities have greater consequences for women, since they tend to have more serious disability at onset and are more likely to be disabled after a stroke than men, but, importantly, have been shown to benefit just as much from clot-busting treatment as men do.”

One reason for the difference may be that women are much more likely to live alone, so they may arrive later at the hospital or be unaware of when their symptoms started.

“Clot-busting treatments must be given within 4.5 hours of when the stroke occurred to be effective, so delays will make people ineligible for treatment,” Reeves said.

Another reason may be that women often have atypical symptoms of stroke, making it more difficult to diagnose and could result in delaying treatment, he said. Women are more likely to have nontraditional stroke symptoms, such as a loss of alertness, weakness or incontinence.

Reeves said a limitation of his meta-analysis is that the studies differed in their methods and data sampling, making it difficult to compare the results.