Persistent sex-based and gender-based disparities exist across the stroke care continuum, with women less likely to be identified by emergency services, historically receiving less reperfusion therapy, and experiencing worse long-term outcomes including higher rates of poststroke disability, institutionalization, and reduced quality of life.
Women are less likely to be identified by emergency services as having a stroke due to more frequent nonfocal presentations.
Sex disparities in the administration of acute stroke treatments such as IV thrombolysis and mechanical thrombectomy have narrowed, but historical underuse in women contributed to worse outcomes.
Anticoagulation use in atrial fibrillation has improved following the inclusion of female sex as a risk factor in stroke risk scores, although some gaps remain.
Women experience worse long-term poststroke outcomes compared to men, including higher rates of disability, institutionalization, and reduced quality of life.
Poststroke mental health conditions including anxiety, depression, and fatigue disproportionately affect women.
Women are underrepresented in clinical trials, contributing to inequities in stroke care evidence and treatment.
Targeted strategies are recommended to address sex-based stroke care disparities, including sex-sensitive stroke scales and routine sex-disaggregated audits.
This research suggests that significant gaps exist between how men and women experience stroke diagnosis, treatment, and recovery. Women are more likely to have stroke symptoms that don't fit the classic pattern — such as general weakness or confusion rather than one-sided facial drooping or arm weakness — and current emergency tools are not well-designed to catch these differences. As a result, women are less often recognized as having a stroke by emergency responders, which delays treatment. Although the gap in receiving clot-busting drugs and clot-removal procedures has been closing, women have historically received these life-saving treatments less often than men, even though the treatments work equally well for both sexes. This research also suggests that women fare worse after stroke in the long run. They are more likely to be left with lasting disability, to require institutional care, and to report lower quality of life. Women are also more likely to experience anxiety, depression, and fatigue following a stroke. These disparities are worse among older women and those from racially minoritized groups. Contributing factors include biological differences between sexes, biases in the healthcare system, and the fact that women have historically been underrepresented in the clinical trials that shape stroke treatment guidelines. The paper recommends several practical steps to close these gaps, including developing stroke recognition tools that better capture how symptoms present in women, training healthcare providers to recognize and counteract diagnostic bias, regularly reviewing stroke care data separated by sex to identify where disparities occur, and ensuring more women are included in future research trials. Greater attention to mental health and fatigue in women's poststroke care is also recommended as part of a comprehensive approach to more equitable stroke treatment.
Carcel C. (2026). Sex Differences in Stroke Diagnosis, Treatment, and Outcome.. Continuum (Minneapolis, Minn.). https://doi.org/10.1212/cont.0000000000001709