Women with severe stroke less likely to be sent to stroke centers than men.

Women with severe stroke less likely to be sent to stroke centers than men.

Women with Severe Strokes Less Likely to Receive Specialized Care


When it comes to strokes, women with severe cases are less likely to be sent to comprehensive stroke centers compared to men, according to a study conducted by researchers at the University of Texas Health Science Center at Houston. Despite experiencing worse symptoms and living about the same distance from these specialized centers, women with a severe type of stroke, known as a large vessel occlusion acute ischemic stroke, were found to be approximately 9% less likely than men to receive the specialized care they need.

Large vessel occlusion acute ischemic strokes occur when a major artery in the brain is blocked, accounting for an estimated 24% to 46% of all ischemic strokes. Prompt treatment is crucial for stroke patients, as the faster the vessel is opened, the better the patient’s chances for a positive outcome. Comprehensive stroke centers are designed to provide the best and most efficient care possible, ensuring timely treatment and minimizing the risk of long-term complications.

Dr. Sunil Sheth, a co-author of the study and an associate professor of neurology, emphasized the importance of identifying the reasons behind this gender disparity in routing decisions. “Getting to the granular level of what went into a hospital’s routing decision will be very important for future studies,” Sheth stated. While the study did not delve into the specific reasons for this discrepancy, Sheth suggests gender bias may play a role.

To investigate this issue, the researchers analyzed data from a multi-hospital registry for the greater Houston area from January 2019 to June 2020. They focused on patients with large vessel occlusion acute ischemic strokes and compared the prehospital routing of men and women to comprehensive stroke centers capable of performing endovascular therapy to remove artery-clogging clots.

The study included a total of 503 patients, with approximately 46% being women. It was revealed that among these patients, 82% were routed to comprehensive stroke centers. However, further analysis showed that women with severe strokes were older, with an average age of 73 compared to 65 for men. Additionally, they had higher National Institutes of Health Stroke Scale (NIHSS) scores, indicating more severe symptoms.

The higher NIHSS scores in women can partially be attributed to their advanced age, as age is a known contributing factor to sex differences in stroke severity. Moreover, elderly women are more likely to live alone and experience social isolation, which can result in delayed recognition of stroke symptoms and subsequent delays in seeking medical attention. These factors may contribute to the gender disparity in receiving specialized care.

Interestingly, the distance from a patient’s location to the nearest comprehensive stroke center also played a role in routing decisions. Patients living within a 10-mile distance to the nearest specialized center were found to be 38% more likely to be routed there. This highlights the significance of geographical proximity in receiving appropriate stroke care and emphasizes the need for accessible medical facilities across regions.

Previous studies have shown that women with ischemic stroke are less likely to receive clot-busting intravenous tissue-plasminogen activator (tPA) treatment compared to men. Moreover, women are 33% more likely to be misdiagnosed with non-stroke related issues such as headache or dizziness. These data underscore the importance of addressing gender biases in stroke care and improving the accuracy of diagnosis and treatment decisions for female patients.

According to the U.S. Centers for Disease Control and Prevention, stroke is the fifth-leading cause of death for women. Elderly women, in particular, face a higher risk of death and disability due to strokes, mainly attributed to their age-related risk factors and the severity of their strokes. Proper triage and prehospital routing are crucial for women, as identifying large vessel occlusions in older women using current screening tools may prove challenging. Further investigation is needed to determine if age, premorbidity, or nontraditional stroke symptoms contribute to the underdiagnosis in women.

The study, published in the Journal of the American Heart Association, sheds light on the gender disparity in stroke care and emphasizes the importance of equal access to specialized facilities for all patients. By addressing implicit biases and implementing appropriate triage processes, healthcare systems can ensure that women with severe strokes receive prompt and effective treatment, thus reducing mortality rates and improving outcomes.


The gender disparity in routing decisions for stroke centers has significant implications for women’s health. Despite experiencing worse symptoms and living in proximity to these specialized facilities, women with severe strokes are less likely to receive the specialized care they require. Implicit gender biases may play a role in this discrepancy, highlighting the need for conscious efforts to address and rectify them.

By examining the reasons behind this gender disparity and implementing more inclusive and non-biased routing processes, healthcare systems can enhance the outcomes and overall quality of care for female stroke patients. Greater accessibility to comprehensive stroke centers and accurate diagnosis tools tailored to older women’s unique needs are essential for reducing mortality rates and preventing disability.