Biological Sex Differences in Risk Factors and Outcomes Among Hospitalized Adults With Stroke in Lusaka, Zambia.

Abstract

We investigated sex differences in clinical characteristics and outcomes among hospitalized adults with stroke in Zambia. We retrospectively collected information for 324 consecutively hospitalized adults with stroke on the neurology service at the University Teaching Hospital in Lusaka, Zambia, between October 2018 and March 2019. Stroke characteristics were then compared by biological sex. Female participants constituted 62% (n = 200) of the cohort, were older (61 ± 19 vs 57 ± 16 years, <i>p</i> = 0.06), had fewer hemorrhagic stroke than male participants (22% vs 37%, <i>p</i> = 0.001), and had higher rates of hypertension (84% vs 74%, <i>p</i> = 0.04), diabetes (19% vs 13%, <i>p</i> = 0.04), heart disease (38% vs 27%, <i>p</i> = 0.04), and history of stroke (26% vs 14%, <i>p</i> = 0.01). Male participants had higher rates of alcohol (33% vs 4%, <i>p</i> < 0.001) and tobacco (19% vs 2%, <i>p</i> < 0.001) use. Female participants were less likely to have neuroimaging completed during their hospitalization (82% vs 94%, <i>p</i> = 0.002) and had higher 90 days postdischarge mortality (28% vs 10%, <i>p</i> = 0.002) independent of age and stroke subtype (OR 2.48, 95% CI 1.1-5.58, <i>p</i> = 0.03). Female participants in this Zambian stroke cohort had a higher prevalence of vascular risk factors but were less likely to have neuroimaging completed. Postdischarge mortality was markedly higher among female participants even after adjusting for age and stroke subtype. Our data highlight the need for future studies of social and socioeconomic factors that may influence stroke-related outcomes.