@article{2987622,
    title = "Age and sex differences in ischemic stroke treatment in a nationwide analysis of 1.11 million hospitalized cases",
    author = "Weber, R. and Krogias, C. and Eyding, J. and Bartig, D. and Meves, S.H. and Katsanos, A.H. and Caso, V. and Hacke, W.",
    journal = "ISRN Stroke",
    year = "2019",
    volume = "50",
    number = "12",
    pages = "3494-3502",
    publisher = "Lippincott Williams and Wilkins",
    issn = "2090-9454",
    doi = "10.1161/STROKEAHA.119.026723",
    keywords = "fibrinolytic agent, adult;  aged;  Article;  brain ischemia;  female;  fibrinolytic therapy;  Germany;  groups by age;  hospital mortality;  hospital patient;  human;  intensive care unit;  major clinical study;  male;  mechanical thrombectomy;  middle aged;  priority journal;  recanalization;  recurrent disease;  sex difference;  stroke patient;  stroke unit;  very elderly;  age;  brain ischemia;  cerebrovascular accident;  endovascular surgery;  health care delivery;  hospital mortality;  hospital subdivisions and components;  sex factor;  thrombectomy;  young adult, Adult;  Age Factors;  Aged;  Aged, 80 and over;  Brain Ischemia;  Endovascular Procedures;  Female;  Germany;  Health Services Accessibility;  Hospital Mortality;  Hospital Units;  Humans;  Male;  Middle Aged;  Sex Factors;  Stroke;  Thrombectomy;  Thrombolytic Therapy;  Young Adult",
    abstract = "Background and Purpose-To date, there is still uncertainty about age and sex differences in access to stroke unit treatmentand use of intravenous thrombolysis (IVT), while age and sex differences have not been investigated for the new treatmentoption of mechanical thrombectomy (MT). We, therefore, undertook a complete nationwide analysis of all hospitalizedischemic stroke patients in Germany from 2013 to 2017.Methods-We used the nationwide administrative database of the German Federal Statistical Office and investigated accessto stroke unit treatment, IVT, MT, and in-hospital mortality. Patients were subdivided into 6 predefined age groups(20-44, 45-59, 60-69, 70-79, 80-89, and >90 years). Pooled overall and age group estimates were calculated using therandom-effects model. To evaluate potential sex disparities, we estimated odds ratios (ORs) with 95% CIs.Results-A total of 1 112570 patients were hospitalized for first or recurrent ischemic stroke from 2013 to 2017. Overall,stroke unit treatment increased significantly from 66.8% in 2013 to 73.5% in 2017, as did IVT (from 12.4% to 15.9%)and MT (from 2.4% to 5.8%; all P<0.001). Although the difference became smaller over time, patients =80 years of agestill received significantly less often treatments. Men of all age groups had a significantly higher probability receivingstroke unit treatment (OR, 1.11; 95% CI, 1.09-1.12) and lower in-hospital mortality (OR, 0.91; 95% CI, 0.89-0.93). Nodisparity was observed in the use of IVT (OR, 1.00; 95% CI, 0.98-1.01), while women of all ages were treated more oftenwith MT (OR, 1.26; 95% CI, 1.22-1.30).Conclusions-Access to stroke unit treatment has to be increased in both older patients and women of all ages. While therewas no sex difference in IVT use, it is important to further investigate the significantly higher frequency of MT in womenwith ischemic stroke irrespective of age. © 2019 American Heart Association, Inc."
}