CNR - Institute of Neuroscience CNR
Institute of Neuroscience


Epidemiology of stroke: frequency, outcome and resource utilization

Studies have reported sex differences in the management of patients with ischemic heart disease. When compared with men, women were more likely to receive, in the acute phase, a less aggressive therapy and, in general, a reduced amount of diagnostic and therapeutic procedures. The information on the existence of sex differences in management of stroke patients is still scarce.

The information on sex-related differences may provide useful insight for risk factors control as well as for acute and long-term care interventions, such as the establishment of more appropriate in-hospital diagnostic and therapeutic pathways, and the setting-up of prevention and rehabilitation programs. The longer life-expectancy of women, and the direct relationship between stroke and advanced age, suggest that older female patients will be those bearing the major burden of the disease, both in terms of severity and residual disability.


The objective of the present study was to determine whether there were differences between sexes in risk factors, clinical presentation, resource use, and 3-month outcome in patients hospitalized for acute stroke in a large European setting.

The study was prospective and involved 12 centers (22 hospitals) in 7 countries: England, France, Germany, Hungary, Italy, Portugal, and Spain. The hospitals were chosen because they contained staff interested in stroke research. They provide general acute care to the local population, most are community hospitals, serving up to 150 000 inhabitants. Some centers have acute stroke-monitoring facilities. Patient-based data collection began in September 1993, and related to all first-ever stroke admissions for the subsequent year. Stroke was defined according to the World Health Organization. The study variables were chosen after an initial workshop and were similar to those used by the Monitoring Trends and Determinants in Cardiovascular Disease (MONICA) Stroke Study.

Selected results

Clinical state at time of maximum impairment by sex.


Stroke pathological types and clinical syndromes of ischemic stroke by sex.


Resource use during hospitalization by sex.


Predictors of 3-Month Death, Disability (Barthel Index 0-14), and Handicap (Rankin Scale 2-5)



Although no major disparities in access to healthcare by sex are currently reported in Europe, sex differences in indicators of social status such as education, occupation, and income may lead different levels of patient compliance, or cause miscommunication between patients and physicians, causing poorer control of risk factors, or the incorrect use of preventive treatments such as the anticoagulant therapy in fibrillating patients. A more strict adherence to international guidelines for stroke prevention seems advisable to remove sex differences in management of individuals at risk, differences that may be acting before stroke onset and hospitalization.

In conclusion, our findings suggest a complex interplay of sociodemographic factors, preexisting frailty, and disease severity in determining outcome of stroke. Although other interventions may require a long-term perspective, the achievement of a diagnostic accuracy similar to that reached in male patients and aimed at a better definition of pathogenic features, together with a particular attention to the acute-phase predictors of functional outcome, seem affordable objectives, with possible positive consequences on general management and prognosis.


  • European Registers of Stroke (EROS) Investigators, Heuschmann PU, Di Carlo A, Bejot Y, Rastenyte D, Ryglewicz D, Sarti C, Torrent M, Wolfe CD (2009) Incidence of stroke in Europe at the beginning of the 21st century. Stroke 40:1557-63.


1991 - 1998: The ILSA was supported by the Italian National Research Council with annual grants to each research unit


  • O. Tofani, A. Rosselli, F. Cordopatri, G. Giuntoli, M. Magherini, P. Pennati, S. Tatini, F. Trucco, E. Pieragnoli, F. Manetti, C. Mugnaini, L. Bagnoli, O. Marrazza, G.P. Menegazzo, I. Meucci, G. Landini, C. Cappelletti, M.C. Baruffi, S. Spolveri, M. Ricca, P. Adriani, C. Bianco, Health Area 10, Florence, Italy.
  • G. Trefoloni, P. Vanni, Newcastle General Hospital, UK.
  • D.H. Barer, Y. Ellul, INRCA Fermo, Italy.
  • M. Ayana, P. Gompertz, R. Harwood, P. Pound, Royal Free Hospital London, UK.
  • H. Rogers, University of Newcastle, UK.
  • M. Menassa, M. Lemesle, Hôpital General, Dijon, France.
  • K. Kunze, Neurologischen Universitatsklinik, Hamburg-Eppendorf, Germany.
  • J. Berger, University Hospital Eppendorf, Hamburg, Germany.
  • B. Haussler, W. Mall, H. Nolting, Institut fur Gesundheits und Sozialforschung, Berlin, Germany.
  • Z. Nagy, C. Ovary, Z. Vokoq, National Stroke Center, Budapest, Hungary.
  • M. Carrageta, J. Namora, I. Remidios, A. Santos, J. Coisinha, Hospital Garcia de Orta, Almada, Portugal.
  • J. Dias, Direcção Geral de Saùde, Lisboa, Portugal.
  • Arias, P. Casquero, S. Montserrat, M. Torrent, Gabinete de Estudios, Palma de Mallorca, Spain.


PI photo

Antonio Salvatore Di Carlo

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Participating staff