{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T20:36:15Z","timestamp":1792787775060,"version":"4.5.0"},"reference-count":26,"publisher":"SAGE Publications","issue":"8","license":[{"start":{"date-parts":[[2026,2,28]],"date-time":"2026-02-28T00:00:00Z","timestamp":1772236800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"name":"Sichuan Credit Pharmaceutical"},{"DOI":"10.13039\/501100000925","name":"National Health and Medical Research Council","doi-asserted-by":"publisher","award":["APP1149987"],"award-info":[{"award-number":["APP1149987"]}],"id":[{"id":"10.13039\/501100000925","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100006680","name":"Takeda Medical Research Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100006680","id-type":"DOI","asserted-by":"publisher"}]},{"name":"West China Hospital Outstanding Discipline Development 1\u20133-5 program","award":["ZY2016102"],"award-info":[{"award-number":["ZY2016102"]}]},{"DOI":"10.13039\/501100020171","name":"foreign, commonwealth and development office","doi-asserted-by":"publisher","award":["MR\/T005009\/1"],"award-info":[{"award-number":["MR\/T005009\/1"]}],"id":[{"id":"10.13039\/501100020171","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000265","name":"medical research council","doi-asserted-by":"publisher","award":["MR\/T005009\/1"],"award-info":[{"award-number":["MR\/T005009\/1"]}],"id":[{"id":"10.13039\/501100000265","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000276","name":"department of health and social care","doi-asserted-by":"publisher","award":["MR\/T005009\/1"],"award-info":[{"award-number":["MR\/T005009\/1"]}],"id":[{"id":"10.13039\/501100000276","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Wellcome Trust","award":["MR\/T005009\/1"],"award-info":[{"award-number":["MR\/T005009\/1"]}],"id":[{"id":"https:\/\/ror.org\/029chgv08","id-type":"ROR","asserted-by":"crossref"}]},{"name":"Takeda","id":[{"id":"https:\/\/ror.org\/04hjbmv12","id-type":"ROR","asserted-by":"crossref"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["International Journal of Stroke"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction:<\/jats:title>\n                    <jats:p>As the management of intracerebral hemorrhage (ICH) shifts from historical inertia to more proactive, evidence-based care, ensuring sex-equitable access to best-practice stroke care is increasingly important. Data on sex differences in access to care for ICH remains limited and often conflicting. More robust evidence is required to understand where disparities may exist to inform targeted interventions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aims:<\/jats:title>\n                    <jats:p>We aimed to determine sex differences in the clinical and surgical management of patients with acute ICH who participated in the third Intensive Blood Pressure Reduction in Acute Cerebral Haemorrhage Trial (INTERACT3).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>We performed a post hoc analysis of INTERACT3, an international stepped-wedge, cluster-randomised trial undertaken in 121 hospitals across 9 low- to middle-income countries and 1 high-income country. The trial aimed to evaluate a care bundle composed of intensive blood-pressure lowering, rapid correction of hyperglycemia, fever control, and reversal of anticoagulation; in adults presenting within 6\u2009h of ICH onset. We used mixed-effects logistic regression to evaluate sex differences in access to surgical interventions, admission to an intensive care unit or acute stroke unit, assisted feeding, physiotherapy, occupational therapy, withdrawal of care, and use of pharmacological therapies (antiepileptic drugs, mannitol, dexamethasone, and statins). Patterns of care were further evaluated using latent class analysis, with sex differences analyzed using the same regression framework.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Of 7036 patients with ICH, 2533 (36%) were female. Females were older and had more severe neurological deficits. Overall care provision was similar across sexes. However, females were more likely to receive assisted feeding (odds ratio [OR] 1.15, 95% CI = 1.02\u20131.31), and were less likely to withdraw from active care (OR 0.41, 95% CI = 0.19\u20130.87) than males. Surgical interventions were accessed at similar rates among sexes, a finding that persisted in analyses restricted to supratentorial ICH with hematoma volumes\u2009\u2a7e\u200930\u2009mL. Three distinct care classes were identified: high-intensity, high-rehabilitation, and low-intensity, with females and males having comparable distributions within the classes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Following acute ICH, females generally receive similar active acute care interventions as males, except for observed differences in access to assisted feeding and decision to withdraw from active care. These findings suggest that equal access to ICH interventions for females and males is feasible and exists in some settings. However, disparities in certain key interventions remain and present actionable opportunities for improvement. Further research is needed to explore not only access but also the timing and frequency of these interventions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Data access statement:<\/jats:title>\n                    <jats:p>Individual, de-identified participant data used in these analyses will be shared on request from any qualified investigator after the approval of a protocol and signed data access agreement via both the trial steering committee and the research office of The George Institute for Global Health (Sydney, NSW, Australia).<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/17474930261423639","type":"journal-article","created":{"date-parts":[[2026,2,5]],"date-time":"2026-02-05T12:32:51Z","timestamp":1770294771000},"page":"1150-1158","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Sex differences in the clinical and surgical management after intracerebral hemorrhage: A post hoc analysis of the INTERACT3 clinical trial"],"prefix":"10.1177","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-7076-1539","authenticated-orcid":false,"given":"Ma. Ignacia","family":"Allende","sequence":"first","affiliation":[{"name":"The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8942-953X","authenticated-orcid":false,"given":"Cheryl","family":"Carcel","sequence":"additional","affiliation":[{"name":"The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia"},{"name":"Prince of Wales Clinical School, University of New South Wales, Sydney, NSW, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paula","family":"Mu\u00f1oz-Venturelli","sequence":"additional","affiliation":[{"name":"The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia"},{"name":"Centro de Estudios Cl\u00ednicos, Instituto de Ciencias e Innovaci\u00f3n en Medicina, Facultad de Medicina Cl\u00ednica Alemana, Universidad del Desarrollo, Santiago, Chile"},{"name":"Servicio de Neurolog\u00eda, Departamento de Neurolog\u00eda y Psiquiatr\u00eda, Cl\u00ednica Alemana de Santiago, Facultad de Medicina Cl\u00ednica Alemana, Universidad del Desarrollo, Santiago, Chile"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2444-2869","authenticated-orcid":false,"given":"Katie","family":"Harris","sequence":"additional","affiliation":[{"name":"The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7917-6858","authenticated-orcid":false,"given":"Menglu","family":"Ouyang","sequence":"additional","affiliation":[{"name":"The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lu","family":"Ma","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8367-542X","authenticated-orcid":false,"given":"Xiaoying","family":"Chen","sequence":"additional","affiliation":[{"name":"The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4975-9793","authenticated-orcid":false,"given":"Laurent","family":"Billot","sequence":"additional","affiliation":[{"name":"The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qiang","family":"Li","sequence":"additional","affiliation":[{"name":"The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alejandra","family":"Malavera","sequence":"additional","affiliation":[{"name":"The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xi","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Asita","family":"de Silva","sequence":"additional","affiliation":[{"name":"Clinical Trials Unit, Faculty of Medicine, University of Kelaniya, Colombo, Sri Lanka"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thang Huy","family":"Nguyen","sequence":"additional","affiliation":[{"name":"Department of Cerebrovascular Disease, 115 People\u2019s Hospital, Ho Chi Minh City, Vietnam"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kolawole W","family":"Wahab","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Ilorin &amp; University of Ilorin Teaching Hospital, Ilorin, Nigeria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeyaraj D","family":"Pandian","sequence":"additional","affiliation":[{"name":"Neurology Department, Christian Medical College and Hospital, Ludhiana, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3750-2613","authenticated-orcid":false,"given":"Mohammad","family":"Wasay","sequence":"additional","affiliation":[{"name":"Department of Medicine, The Aga Khan University, Karachi, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0317-843X","authenticated-orcid":false,"given":"Octavio M","family":"Pontes-Neto","sequence":"additional","affiliation":[{"name":"Department of Neuroscience and Behavioural Sciences, Ribeir\u00e3o Preto Medical School, University of S\u00e3o Paulo, Ribeirao Preto, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlos","family":"Abanto","sequence":"additional","affiliation":[{"name":"The Cerebrovascular Disease Research Center, National Institute of Neurological Sciences, Lima, Peru"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Arauz","sequence":"additional","affiliation":[{"name":"Instituto Nacional de Neurologia y Neurocirugia Manuel Velasco Suarez, Mexico City, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chao","family":"You","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6084-1341","authenticated-orcid":false,"given":"Xin","family":"Hu","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lili","family":"Song","sequence":"additional","affiliation":[{"name":"Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Craig S","family":"Anderson","sequence":"additional","affiliation":[{"name":"The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia"},{"name":"Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"for the INTERACT3 Investigators","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,2,28]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(24)00369-7"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1177\/17474930241250259"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2308440"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2313040"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(23)00806-1"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.121.021499"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCRESAHA.121.319915"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12910-017-0179-8"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1007\/s12028-022-01453-y"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.113.002814"},{"key":"e_1_3_3_12_2","unstructured":"United Nations. Transforming our world: the 2030 agenda for sustainable development [Internet] 2015 https:\/\/sdgs.un.org\/sites\/default\/files\/publications\/21252030%20Agenda%20for%20Sustainable%20Development%20web.pdf (2015 accessed 18 July 2025)."},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.STR.20.7.864"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(74)91639-0"},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0000000000004710"},{"key":"e_1_3_3_16_2","doi-asserted-by":"publisher","DOI":"10.4159\/9780674041318"},{"key":"e_1_3_3_17_2","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000004143"},{"key":"e_1_3_3_18_2","first-page":"753","article-title":"Sex-based differences in the outcomes of intracerebral haemorrhage: a systematic review and meta-analysis","volume":"53","author":"Yang L","year":"2023","unstructured":"Yang L, Han J, Qin C, et al. Sex-based differences in the outcomes of intracerebral haemorrhage: a systematic review and meta-analysis. Cerebrovasc Dis 2023; 53: 753\u2013766.","journal-title":"Cerebrovasc Dis"},{"key":"e_1_3_3_19_2","doi-asserted-by":"publisher","DOI":"10.3389\/fneur.2022.832903"},{"key":"e_1_3_3_20_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.124.050207"},{"key":"e_1_3_3_21_2","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.124.036409"},{"key":"e_1_3_3_22_2","doi-asserted-by":"publisher","DOI":"10.1177\/17474930221090133"},{"key":"e_1_3_3_23_2","doi-asserted-by":"publisher","DOI":"10.3389\/fneur.2021.702833"},{"key":"e_1_3_3_24_2","doi-asserted-by":"publisher","DOI":"10.1111\/ijs.12161"},{"key":"e_1_3_3_25_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.STR.0000125858.71051.ca"},{"key":"e_1_3_3_26_2","doi-asserted-by":"publisher","DOI":"10.1159\/000369792"},{"key":"e_1_3_3_27_2","doi-asserted-by":"publisher","DOI":"10.1080\/07853890.2024.2423794"}],"container-title":["International Journal of Stroke"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/17474930261423639","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/17474930261423639","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/17474930261423639","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T13:50:48Z","timestamp":1790344248000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/17474930261423639"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,28]]},"references-count":26,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2026,10]]}},"alternative-id":["10.1177\/17474930261423639"],"URL":"https:\/\/doi.org\/10.1177\/17474930261423639","relation":{},"ISSN":["1747-4930","1747-4949"],"issn-type":[{"value":"1747-4930","type":"print"},{"value":"1747-4949","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,28]]}}}