Paramedics are less likely to identify a stroke in women compared to men, a gap that, if closed, could save lives and significantly reduce healthcare costs. This disparity in stroke diagnosis highlights a critical issue in emergency medical care that demands urgent attention.
A stroke occurs when the blood supply to part of the brain is interrupted, either due to a blockage, known as an ischaemic stroke, or bleeding, termed a haemorrhagic stroke. Ischaemic strokes account for approximately 83% of all stroke cases. The primary emergency treatment for ischaemic strokes is intravenous thrombolysis, a “clot-busting” process that must be administered promptly—ideally within an hour of hospital arrival and no later than 4.5 hours after symptoms begin. Prompt treatment is crucial for enhancing survival and recovery chances.
However, research indicates that not everyone receives equal access to this timely treatment. Notably, ambulance staff are significantly less likely to correctly identify a stroke in women compared to men, a factor that contributes to delays in treatment and poorer outcomes for female patients.
The Gender Gap in Stroke Diagnosis
In Australia, approximately 75% of stroke patients arrive at the hospital by ambulance. When paramedics suspect a stroke, they can expedite patient care by transporting them directly to a specialized stroke care facility and alerting the hospital team to prepare for immediate scans and treatment.
Research reveals that women under 70 are 11% less likely than men to have their strokes recognized by paramedics before reaching the hospital. Although younger men and women experience strokes at similar rates, their symptoms can differ. “Typical” symptoms are more common in men, whereas women often present with “atypical” symptoms.
While both genders are equally likely to exhibit movement and speech difficulties during a stroke, women are more prone to vague symptoms such as general weakness, changes in alertness, or confusion. These atypical symptoms can be easily overlooked, increasing the risk of misdiagnosis, delayed treatment, and preventable harm for women.
Research Findings: Potential Health Gains and Cost Savings
A recent study published in the Medical Journal of Australia (MJA) utilized ambulance and hospital data from a 2022 study in New South Wales. This study highlighted the discrepancy in stroke recognition between genders. From this dataset, researchers identified over 5,500 women under 70 who experienced an ischaemic stroke between 2005 and 2018. They modeled two scenarios: the current rate of stroke identification in women and an improved scenario where women’s strokes are identified at the same rate as men’s.
The findings were significant. Improving the stroke diagnosis rate for women to match that of men resulted in each woman gaining an average of 0.14 extra years of life (approximately 51 days) and 0.08 extra quality-adjusted life years (QALYs), equating to an additional 29 days in full health. This scenario also translated to an average saving of A$2,984 in healthcare costs per woman.
Scaled to a national level, closing this diagnosis gap could result in 252 extra years of life, 144 extra QALYs, and $5.4 million in annual cost savings.
Challenges and Broader Implications
The study faced limitations, including the lack of sex-specific data for every model aspect, reflecting a broader issue of insufficient recognition of sex as a crucial factor in disease understanding. Some model components relied on combined data from both genders, potentially affecting the results. Additionally, the NSW data used for thrombolysis treatment rates were higher than the national average, suggesting that national figures may be slightly overestimated.
This gender disparity in stroke diagnosis is indicative of a broader systemic issue in women’s health, where sex-based differences in diagnosis and treatment often favor men. Women’s symptoms are frequently misinterpreted or dismissed when they do not align with “typical” patterns, leading to delays, missed opportunities for early treatment, and poorer outcomes.
Strategies for Closing the Diagnosis Gap
To address this issue, investing in enhanced training for paramedics and emergency responders to recognize a broader range of stroke presentations could yield significant benefits. Public awareness campaigns highlighting atypical stroke symptoms could also play a pivotal role in improving recognition rates.
Technological advancements, such as mobile stroke units and telemedicine support, may offer part of the solution, provided they are implemented with consideration for sex-specific needs.
This article is republished from The Conversation and authored by Lei Si from Western Sydney University, Laura Emily Downey, and Thomas Gadsden from the George Institute for Global Health. The authors have disclosed no relevant affiliations beyond their academic appointments.
