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Journal article
Sex differences in the impact of acute stroke treatment in a population-based study: a sex-specific propensity score approach
Annals of epidemiology, v 27(8), pp 493-498
01 Aug 2017
PMID: 28935027
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Abstract
Purpose: We investigated whether sex modifies the association of acute stroke treatment on functional outcome using propensity score (PS) methods to minimize confounding and to explore the differential effects of confounders by sex.
Methods: We included tissue plasminogen activator (tPA) treated (n = 84) and nontreated ischemic stroke cases (n = 143) from a population-based stroke study (2008-2013). The PS model that estimated the probability of receiving tPA included interactions between sex and treatment predictors. The outcome model included sex, tPA, and their interaction. In addition, sex-specific PS values were included as a continuous covariate and modeled using splines. We compared the results with conventional methods of statistical adjustment.
Results: Conventional methods of adjustment suggested that women receive greater benefit from tPA than men. After taking into consideration that the influence of confounders, specifically age and stroke severity, differed by sex, we found no sex difference in the tPA-functional outcome association (P =.94).
Conclusions: Using PS methods that considered confounding of the sex x treatment interaction, we did not find that the association of tPA with functional outcome differed for women and men. Our findings may have implications for the methodologic approaches used to address confounding in studies that seek to compare stroke treatment effects by sex. (C) 2017 Elsevier Inc. All rights reserved.
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Details
- Title
- Sex differences in the impact of acute stroke treatment in a population-based study: a sex-specific propensity score approach
- Creators
- Lynda D. Lisabeth - University of MichiganJonggyu Baek - University of MichiganLewis B. Morgenstern - University of MichiganMathew J. Reeves - Michigan State UniversityDevin L. Brown - University of MichiganDarin B. Zahuranec - University of MichiganMelinda A. Smith - Univ Michigan, Stroke Program, Ann Arbor, MI 48109 USABrisa N. Sanchez - University of Michigan
- Publication Details
- Annals of epidemiology, v 27(8), pp 493-498
- Publisher
- Elsevier
- Number of pages
- 6
- Grant note
- R01NS070941 / NATIONAL INSTITUTE OF NEUROLOGICAL DISORDERS AND STROKE; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Institute of Neurological Disorders & Stroke (NINDS) R01NS38916; R01 NS070941 / National Institutes of Health; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA R01HL098065 / NATIONAL HEART, LUNG, AND BLOOD INSTITUTE; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Heart Lung & Blood Institute (NHLBI)
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Epidemiology and Biostatistics
- Web of Science ID
- WOS:000411770700006
- Scopus ID
- 2-s2.0-85043364992
- Other Identifier
- 991020100212504721
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- Collaboration types
- Domestic collaboration
- Web of Science research areas
- Public, Environmental & Occupational Health