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Tuesday, December 5, 2023

Glaring omission of many older women across multiple decades of stroke studies

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New research from the George Institute of Global Health has revealed that older women have been consistently under-represented in decades worth of vital, stroke-related studies.

In the study, published in the latest issue of Neurology®, researchers looked at 281 stroke trials that had at least 100 participants, spanning between 1990 and 2020.

Of the 588,887 participants analysed across the studies, only 37.4 per cent were women, despite the average prevalence of stroke in women across the countries included being 48 percent.

It’s a lack of representation in an area that is especially important to women’s health; in fact, stroke is the second biggest killer of Australian women.

Dr Cheryl Carcel, lead author of the study and a Heart Foundation fellow, says that while both women and men had the same one-in-four risk of experiencing a stroke in their lifetime, women were generally much older and in worse health at the time they have a stroke.

“When women have strokes, they are often older, have more co-morbidities and have more severe strokes,” she tells Aged Care News.

Ironically, the extent of their condition may be a factor precluding them from inclusion in research.

“Some trials with very strict entry criteria exclude participants who are very sick who may not be able to continue with the trial until the end — this may unintentionally exclude women,” Carcel says.

And more research is needed to understand the nature of women’s propensity for worse health outcomes post-stroke.

“There is research to suggest, perhaps biologically, that women are predisposed to have worse outcomes after stroke.

“At the same time, more research needs to be done in terms of tailoring prevention and treatment strategies to improve quality of life after stroke,” Carcel says.

Without further research, it is unclear whether some of the disparity in outcome is another instance of gender bias in the healthcare system.

“Patient attitudes and beliefs can also be a factor, and there can even be a potential bias among the clinical staff conducting the study,” Carcel says.

“Our previous research indicated that how women were treated in hospital and whether they had been on the right medications before their stroke, could be responsible for their poorer outcomes.”

However, the Heart Foundation’s Director of Heart Health Strategy, Julie Anne Mitchell, points to a number of unique, female comorbidities that are worthy of further exploration.

“Women share common risk factors with men, such as high cholesterol and blood pressure, but they also have sex-specific risk factors, including pregnancy-related conditions such as pre-eclampsia and gestational diabetes.

“We need to understand more about all of these risk factors so we can improve prevention and treatment options for women.”

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