To Örebro University

Background and Aims: Previous studies of stroke management and outcome after stroke in Sweden reveal differences between men and women. Our aim was to analyze if these differences have altered over time.

Methods: All stroke events registered in Riksstroke, the Swedish Stroke Register during 2005–2018 were included. We performed unadjusted and age-stratified analyzes.

Results: We identified 335,183 events (161,939 women; 173,244 men). Women were older than men at stroke onset (mean age 78.1 vs. 73.3 years). In both sexes, there was an increase in the proportion of ischemic stroke patients receiving reperfusion therapy 2005–2018 (1.3–16.6% in women; 2.5–16.8% in men) and, among those with atrial fibrillation, oral anticoagulants at discharge (26.4–75.8% in women; 36.7–77.7% in men). There was an increased proportion of patients prescribed statins, but during the entire study period the proportion remained lower in women (31.7–75.3%) in comparison to men (42.6–83.5%). In addition, women were less likely to be treated at stroke or intensive care units (78.4–90.6%) than men (81.9–91.8%). In 2018, unadjusted 28-day case fatality was 14.9% in women and 10.8% in men. For patients under the age of 80, case fatality was 7.2% in both women and men.

Conclusions: In this large nation-wide observational study, we report a more equal care between women and men. Still, women were less often prescribed statins and were less often treated at stroke units. One explanation to these differences could be women’s higher age at stroke onset, with a presumed frailty, but further analyzes are needed to investigate if the disparity is motivated.