Factors related to sex differences in long-term functional decline after acute ischemic stroke

This study evaluated the factors predisposing women to a more substantial functional decline than men in the chronic phase of stroke. Sex differences in functional worsening and improvement, defined as an increase and decrease in one or more modified Rankin Scale scores between the 3-month and each assessment point throughout 5 years after ischemic stroke were examined using data from a multicenter prospective stroke registry in Japan. Logistic regression analysis was performed to estimate the risk of unfavorable outcomes in women after adjusting for potential confounders. The interactions between sex and confounders were also assessed. Among 6848 patients who survived for 5 years poststroke, 39.3% were female. Female survivors were more likely to experience unfavorable functional outcomes throughout 5 years post-stroke than male survivors. The higher risk of functional worsening in women than men was more apparent among patients aged > 75 years and those without limb weakness (P for interaction for age 0.04 and for limb weakness 0.03). Older female patients, frequently experiencing frailty and multimorbidity, should be targeted in poststroke interventions to reduce the burden of long-term disability after stroke. Female patients without apparent motor impairment might also benefit from physical activity programs to maintain muscle strength.