Gender Disparities in Stroke Risk Profiles: A Single Centre Observational Study

Background: The growing stroke burden in Pakistan, particularly in rural populations, poses a serious challenge to the already strained healthcare system. Pakistan currently ranks fifth in the global stroke burden. The absence of population-based studies has limited data on stroke etiology, risk factors, and hyperacute management practices. This study aimed to compare risk factor profiles of male and female stroke patients and assess gender differences in time-to-presentation at a private tertiary care hospital. Methods: This retrospective, cross-sectional study was conducted at Aga Khan University Hospital from January 2016 to December 2018. Patients with ischemic or hemorrhagic stroke were included. De-identified clinical and radiological data, including demographics, vascular risk factors, and treatment details, were analyzed using chi-square and t‐tests, with odds ratios (ORs) calculated where appropriate. Results: Of 1,074 patients, 674 (62.7%) were male and 400 (37.2%) female. Females were older (64.5 vs. 61.1 years, p < 0.001) and had higher admission stroke severity (NIHSS 7.9 vs. 6.3, p < 0.001). Hypertension and atrial fibrillation were more common in females (83.0% vs. 76.4%, p = 0.011; 15.0% vs. 7.3%, p < 0.001), whereas smoking was predominantly male (20.6% vs. 3.0%, p < 0.001). Time-to-presentation did not differ significantly (p = 0.788), with about one-quarter arriving within 4.5 hours. Despite this, only 27 patients (2.8%) received r-tPA, more often men than women (20 vs. 7; OR 1.82, p = 0.218). Discharge mRS scores were similar (p = 0.178). Conclusion: Sex differences were evident in age, stroke severity, hypertension, atrial fibrillation, and smoking, while time-to-presentation and outcomes were comparable. Despite similar time-to-presentation, fewer women received thrombolysis. These findings mirror global literature, where women present older and with greater severity, while men carry higher lifestyle-related risks. Improving awareness, early detection, and equitable access to hyperacute therapies are essential to addressing these disparities in Pakistan’s overburdened healthcare system, and developing sex-specific strategies may improve both prevention and treatment outcomes.