Research Article| Volume 25, ISSUE 3, P504-510, March 2016

Gender and Time to Arrival among Ischemic Stroke Patients in the Greater Cincinnati/Northern Kentucky Stroke Study


      Some studies of stroke patients report longer prehospital delays in women, but others conflict; studies vary in their inclusion of factors including age and stroke severity. We aimed to investigate the relationship between gender and time to emergency department (ED) arrival and the influence of age and stroke severity on this relationship.


      Ischemic stroke patients 20 years old or older who presented to 15 hospitals within a 5-county region of Greater Cincinnati/Northern Kentucky during 2010 were included. Time from symptom onset to ED arrival and covariates were abstracted by study nurses and reviewed by study physicians. Data were analyzed using logistic regression with time to arrival dichotomized at 3 hours or less in the overall sample and then stratified by National Institutes of Health Stroke Scale (NIHSS) and age.


      1991 strokes (55% women) were included. Time to arrival was slightly longer in women (geometric mean 337 minutes [95% confidence interval {CI} 307-369] versus 297 [95% CI 268-329], P = .05), and 24% of women versus 27% of men arrived within 3 hours (P = .15). After adjusting for age, race, NIHSS, living situation, and other covariates, gender was not associated with delayed time to arrival (OR = 1.00, 95% CI .78-1.28). This did not change across age or NIHSS categories.


      After adjusting for factors including age, NIHSS score, and living alone, women and men with ischemic stroke had similar times to arrival. Arrival time is not likely a major contributor to differences in outcome between men and women.

      Key Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Stroke and Cerebrovascular Diseases
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Foerch C.
        • Misselwitz B.
        • Humpich M.
        • et al.
        Sex disparity in the access of elderly patients to acute stroke care.
        Stroke. 2007; 38: 2123-2126
        • Mandelzweig L.
        • Goldbourt U.
        • Boyko V.
        • et al.
        Perceptual, social, and behavioral factors associated with delays in seeking medical care in patients with symptoms of acute stroke.
        Stroke. 2006; 37: 1248-1253
        • Park S.J.
        • Shin S.D.
        • Ro Y.S.
        • et al.
        Gender differences in emergency stroke care and hospital outcome in acute ischemic stroke: a multicenter observational study.
        Am J Emerg Med. 2013; 31: 178-184
        • Smith M.A.
        • Lisabeth L.D.
        • Bonikowski F.
        • et al.
        The role of ethnicity, sex, and language on delay to hospital arrival for acute ischemic stroke.
        Stroke. 2010; 41: 905-909
        • de Ridder I.
        • Dirks M.
        • Niessen L.
        • et al.
        Unequal access to treatment with intravenous alteplase for women with acute ischemic stroke.
        Stroke. 2013; 44: 2610-2612
        • Di Carlo A.
        • Lamassa M.
        • Baldereschi M.
        • et al.
        Sex differences in the clinical presentation, resource use, and 3-month outcome of acute stroke in Europe: data from a multicenter multinational hospital-based registry.
        Stroke. 2003; 34: 1114-1119
        • Madsen T.E.
        • Khoury J.C.
        • Alwell K.A.
        • et al.
        Analysis of tissue plasminogen activator eligibility by sex in the Greater Cincinnati/Northern Kentucky Stroke Study.
        Stroke. 2015; 46: 717-721
        • Rossnagel K.
        • Jungehulsing G.J.
        • Nolte C.H.
        • et al.
        Out-of-hospital delays in patients with acute stroke.
        Ann Emerg Med. 2004; 44: 476-483
        • Turan T.N.
        • Hertzberg V.
        • Weiss P.
        • et al.
        Clinical characteristics of patients with early hospital arrival after stroke symptom onset.
        J Stroke Cerebrovasc Dis. 2005; 14: 272-277
        • Lorenzano S.
        • Ahmed N.
        • Falcou A.
        • et al.
        Does sex influence the response to intravenous thrombolysis in ischemic stroke? Answers from safe implementation of treatments in Stroke-International Stroke Thrombolysis Register.
        Stroke. 2013; 44: 3401-3406
        • Gattringer T.
        • Ferrari J.
        • Knoflach M.
        • et al.
        Sex-related differences of acute stroke unit care: results from the Austrian stroke unit registry.
        Stroke. 2014; 45: 1632-1638
        • Gall S.L.
        • Tran P.L.
        • Martin K.
        • et al.
        Sex differences in long-term outcomes after stroke: functional outcomes, handicap, and quality of life.
        Stroke. 2012; 43: 1982-1987
        • Lisabeth L.D.
        • Reeves M.J.
        • Baek J.
        • et al.
        Factors influencing sex differences in poststroke functional outcome.
        Stroke. 2015; 46: 860-863
        • Bushnell C.
        • McCullough L.D.
        • Awad I.A.
        • et al.
        Guidelines for the prevention of stroke in women: a statement for healthcare professionals from the American Heart Association/American Stroke Association.
        Stroke. 2014; 45: 1545-1588
        • Reeves M.
        • Bhatt A.
        • Jajou P.
        • et al.
        Sex differences in the use of intravenous rt-PA thrombolysis treatment for acute ischemic stroke: a meta-analysis.
        Stroke. 2009; 40: 1743-1749
        • Broderick J.
        • Brott T.
        • Kothari R.
        • et al.
        The Greater Cincinnati/Northern Kentucky Stroke Study: preliminary first-ever and total incidence rates of stroke among blacks.
        Stroke. 1998; 29: 415-421
        • Williams L.S.
        • Yilmaz E.Y.
        • Lopez-Yunez A.M.
        Retrospective assessment of initial stroke severity with the NIH Stroke Scale.
        Stroke. 2000; 31: 858-862
        • Labiche L.A.
        • Chan W.
        • Saldin K.R.
        • et al.
        Sex and acute stroke presentation.
        Ann Emerg Med. 2002; 40: 453-460
        • Reeves M.
        • Khoury J.
        • Alwell K.
        • et al.
        Distribution of National Institutes of Health Stroke Scale in the Cincinnati/Northern Kentucky Stroke Study.
        Stroke. 2013; 44: 3211-3213
        • Romano J.G.
        • Smith E.E.
        • Liang L.
        • et al.
        Outcomes in mild acute ischemic stroke treated with intravenous thrombolysis: a retrospective analysis of the Get With the Guidelines-Stroke registry.
        JAMA Neurol. 2015; 72: 423-431
        • Smith E.E.
        • Fonarow G.C.
        • Reeves M.J.
        • et al.
        Outcomes in mild or rapidly improving stroke not treated with intravenous recombinant tissue-type plasminogen activator: findings from Get With The Guidelines-Stroke.
        Stroke. 2011; 42: 3110-3115
        • Adeoye O.
        • Lindsell C.
        • Broderick J.
        • et al.
        Emergency medical services use by stroke patients: a population-based study.
        Am J Emerg Med. 2009; 27: 141-145
        • Kleindorfer D.
        • Lindsell C.J.
        • Moomaw C.J.
        • et al.
        Which stroke symptoms prompt a 911 call? A population-based study.
        Am J Emerg Med. 2010; 28: 607-612