Supplementary Material for: Acute care, secondary prevention, and outcomes after ischaemic and haemorrhagic stroke in men and women: a data-linkage study

Introduction
There is evidence that sex differences exist in stroke presentation, risk factors, severity, treatment, and outcomes. To further understand this, we explored how sex differences influence acute stroke management, secondary prevention prescribing and mortality outcomes in a well-characterised cohort of first-ever stroke patients in Scotland.

Methods
This is a retrospective, population-based, data-linkage study of stroke admissions to acute care hospitals in Scotland between 1 January 2011 and 31 December 2018. Data sources included the Scottish Stroke Care Audit (SSCA), the Prescribing Information System (PIS), the Scottish Morbidity Record 01 (SMR01), and the National Records of Scotland (NRS) Death Records. Multivariable logistic regression was used to explore the association between patient sex, acute stroke care and secondary prevention prescribing, while Cox proportional hazards models were used to explore the association between patient sex and all-cause mortality up to one year after index event.

Results
This study included 5901 patients with a first-ever intracerebral haemorrhage (ICH) and 47 087 patients with a first-ever acute ischaemic stroke (AIS). After an ICH, women had significantly lower odds of receiving all components of the stroke care bundle (adjusted odds ratio (aOR), 0.78; 95% confidence interval (CI), 0.69 – 0.87) and were less likely to be prescribed antihypertensives within ninety days after discharge (aOR, 0.78; 95% CI, 0.63 – 0.97) to usual place of residence. There was no sex difference in stroke care bundle achievement for those admitted with AIS, however, women had significantly lower odds of receiving antihypertensives, lipid-lowering drugs or oral anticoagulants (OAC) after discharge. The risk of all-cause mortality was lower in women at one year after both ICH (adjusted hazard ratio (aHR), 0.90; 95% CI, 0.83 – 0.98) and AIS (aHR, 0.91; 95% CI, 0.87 – 0.95) after adjusting for potential confounders.

Conclusion
The sex differences in stroke treatment and outcomes may be partly explained by the older age of women at the time of stroke, which influences stroke presentation, severity, and prognosis. However, following adjustment, women had reduced risk of all-cause mortality after both ICH and AIS.