Sex differences in stroke

Abstract

An understanding of sex differences in terms of the risk of disease and its influence on therapeutic interventions can lead to improved disease recognition and treatment for women and men. The overall goal of this thesis was to identify gaps in knowledge in the reporting of sex differences in stroke by using a series of systematic approaches to examine the reporting of sex and gender differences more generally and in stroke. First, in order to determine whether funding agencies and peer-reviewed journals in Australia have policies on the collection, analysis and reporting of sex and gender-specific health data, I performed a qualitative survey utilising web-based searches and interviews. Then I narrowed the focus to stroke where I examined the temporal and regional trends in female participation and the reporting of sex differences in randomised controlled trials identified from ClinicalTrials.gov. Finally, three databases were explored to detect where the sex differences were in stroke: (i) a prospective, population-based cohort study, UK Biobank, was used to identify major risk factors in women and men with stroke; (ii) an individual participant data meta-analysis was performed on five large international stroke randomised controlled trials to examine sex differences in outcome and treatment; and (iii) an Australian cohort study on young stroke survivors was examined for sex differences in returning to unpaid work. The statistical methods used for this work were logistic regression, cox regression and multivariable analysis. Analysing results by sex and gender in medical research is important because this may lead to personalised prevention and treatment strategies. In stroke, researchers need to consider enrolling more women in clinical trials and to report results by sex.