Older stroke survivors in the United States, particularly women, commonly experience social participation restrictions possibly due to prestroke health and sex differences in social activities, according to study findings published in Stroke.

Sex differences in participation restriction and contributors to these differences among community-dwelling older stroke survivors were examined and compared with a similar population but without stroke history.

The investigators conducted a nationwide observational study using data from the US NHATS (National Health and Aging Trends Study; a nationally representative longitudinal study of Medicare beneficiaries aged ≥65 years), 2011 to 2022, to identify incident stroke survivors aged at least 65 years. NHATS oversamples individuals aged at least 90 years and non-Hispanic Black individuals. Participants self-reported via interview that they experienced restricted participation in the year of stroke onset for visiting friends and family and going out for enjoyment, as well as restricted participation in the past month in clubs, classes, and religious services.

These results suggest that future social or clinical interventions aimed at promoting poststroke social participation may need to be sex-specific.

Overall, 469 stroke survivors (56.6% women; 11.0% non-Hispanic Black) half of whom were aged 75 to 84 years, were included in the analysis. Women vs men were more likely to be older, less educated, not currently driving, living alone, widowed, and experience worse physical capacity with more activity limitations. Additionally, women tended to have more anxiety, lack access to technology, and have larger social networks. Similar sex differences were noted among a non-stroke comparator group. Stroke survivors, compared with those in the non-stroke population, were more likely to be older, less educated, widowed, have anxiety and depression, use technology, and have a smaller social network.

The investigators wrote that women vs men experienced a higher unadjusted prevalence of any participation restriction (40.3% vs 29.4%; odds ratio [OR], 1.90; 95% CI, 1.21-2.99) and restriction attending religious services (27.5% vs 19.0%; OR, 1.80; 95% CI, 1.08-3.02).

After individual adjustment for driving mobility, marital status, and physical capacity, these sex differences were mostly attenuated, more so following adjustment for activity limitations, living alone, and comorbidities. After simultaneously adjusting for all of these factors, no significant sex differences were found for any participation restrictions (adjusted [a]OR, 1.36; 95% CI, 0.70-2.65). The aOR for restrictions in religious service attendance was 1.36 (95% CI, 0.74-2.49).

Study limitations include possible temporal bias in assessment of post-stroke participation restriction, over-adjustment bias, and reporting bias in self-reports. Additionally, residual confounding was associated with lack of data on stroke severity.

“Social participation restrictions are prevalent among older stroke survivors, particularly for women, which appears to be attributable to sex differences in social factors and prestroke health,” the investigators concluded. “These results suggest that future social or clinical interventions aimed at promoting poststroke social participation may need to be sex-specific.”

This article originally appeared on The Cardiology Advisor