Long term postischemic stroke mortality in diabetes: A veteran cohort analysis

Masoor Kamalesh, Jianzhao Shen, George J. Eckert

Research output: Contribution to journalArticle

35 Citations (Scopus)

Abstract

Background and Purpose: Recent data on stroke mortality in diabetics in the United States is lacking. We investigated trends in diabetes prevalence and stroke morality among diabetics in a large veteran cohort. Methods: The Patient Treatment File was used to identify all patients discharged from any Veterans hospital between October 1990 and September 1997 with a diagnosis of ischemic stroke (ICD-9-CM codes 434, 436) listed as primary diagnosis. Demographic, morbidity, and mortality data were recorded. Chi-square tests were used to examine differences between diabetics and nondiabetics, and t tests were used for continuous variables. Cox proportional hazards regression was used to examine the effects of diabetes (DM) on the survival times controlling for multiple covariates. Results: Of 48 733 ischemic stroke patients identified, 98% were male and 13 925 (25%) had DM. Mean age was similar between DM and non-DM (67.2 versus 67.5, P≤NS). Prevalence of DM among stroke subjects increased from 25% to 31%. Charlson index >2 was much higher in DM (68.2% versus 47.9%, P<0.001). Mortality at 60 days and 1 year was similar in both groups (2.9 versus 2.7%, P≤NS; 12.6 versus 13.1, P≤NS). Kaplan-Meier survival plot showed that DM had shorter long term survival time (log-rank, P<0.001). Multivariate Cox proportional hazards regression showed a higher risk of death for diabetics (HR≤1.15, 95% CI 1.11 to 1.19, P<0.001). Conclusion: Despite greater comorbidity, postacute ischemic stroke mortality at 60 days and 1 year is not different between subjects with and without DM. Long term mortality after stroke is much lower among DM than that reported in older studies.

Original languageEnglish
Pages (from-to)2727-2731
Number of pages5
JournalStroke
Volume39
Issue number10
DOIs
StatePublished - Oct 1 2008

Fingerprint

Veterans
Cohort Studies
Stroke
Mortality
Survival
Veterans Hospitals
International Classification of Diseases
Chi-Square Distribution
Comorbidity
Demography
Morbidity

Keywords

  • Diabetes
  • Mortality
  • Stroke

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Clinical Neurology
  • Advanced and Specialized Nursing
  • Medicine(all)

Cite this

Long term postischemic stroke mortality in diabetes : A veteran cohort analysis. / Kamalesh, Masoor; Shen, Jianzhao; Eckert, George J.

In: Stroke, Vol. 39, No. 10, 01.10.2008, p. 2727-2731.

Research output: Contribution to journalArticle

Kamalesh, Masoor ; Shen, Jianzhao ; Eckert, George J. / Long term postischemic stroke mortality in diabetes : A veteran cohort analysis. In: Stroke. 2008 ; Vol. 39, No. 10. pp. 2727-2731.
@article{e1d62b6ef54c4dca8f6320593b207295,
title = "Long term postischemic stroke mortality in diabetes: A veteran cohort analysis",
abstract = "Background and Purpose: Recent data on stroke mortality in diabetics in the United States is lacking. We investigated trends in diabetes prevalence and stroke morality among diabetics in a large veteran cohort. Methods: The Patient Treatment File was used to identify all patients discharged from any Veterans hospital between October 1990 and September 1997 with a diagnosis of ischemic stroke (ICD-9-CM codes 434, 436) listed as primary diagnosis. Demographic, morbidity, and mortality data were recorded. Chi-square tests were used to examine differences between diabetics and nondiabetics, and t tests were used for continuous variables. Cox proportional hazards regression was used to examine the effects of diabetes (DM) on the survival times controlling for multiple covariates. Results: Of 48 733 ischemic stroke patients identified, 98{\%} were male and 13 925 (25{\%}) had DM. Mean age was similar between DM and non-DM (67.2 versus 67.5, P≤NS). Prevalence of DM among stroke subjects increased from 25{\%} to 31{\%}. Charlson index >2 was much higher in DM (68.2{\%} versus 47.9{\%}, P<0.001). Mortality at 60 days and 1 year was similar in both groups (2.9 versus 2.7{\%}, P≤NS; 12.6 versus 13.1, P≤NS). Kaplan-Meier survival plot showed that DM had shorter long term survival time (log-rank, P<0.001). Multivariate Cox proportional hazards regression showed a higher risk of death for diabetics (HR≤1.15, 95{\%} CI 1.11 to 1.19, P<0.001). Conclusion: Despite greater comorbidity, postacute ischemic stroke mortality at 60 days and 1 year is not different between subjects with and without DM. Long term mortality after stroke is much lower among DM than that reported in older studies.",
keywords = "Diabetes, Mortality, Stroke",
author = "Masoor Kamalesh and Jianzhao Shen and Eckert, {George J.}",
year = "2008",
month = "10",
day = "1",
doi = "10.1161/STROKEAHA.108.517441",
language = "English",
volume = "39",
pages = "2727--2731",
journal = "Stroke",
issn = "0039-2499",
publisher = "Lippincott Williams and Wilkins",
number = "10",

}

TY - JOUR

T1 - Long term postischemic stroke mortality in diabetes

T2 - A veteran cohort analysis

AU - Kamalesh, Masoor

AU - Shen, Jianzhao

AU - Eckert, George J.

PY - 2008/10/1

Y1 - 2008/10/1

N2 - Background and Purpose: Recent data on stroke mortality in diabetics in the United States is lacking. We investigated trends in diabetes prevalence and stroke morality among diabetics in a large veteran cohort. Methods: The Patient Treatment File was used to identify all patients discharged from any Veterans hospital between October 1990 and September 1997 with a diagnosis of ischemic stroke (ICD-9-CM codes 434, 436) listed as primary diagnosis. Demographic, morbidity, and mortality data were recorded. Chi-square tests were used to examine differences between diabetics and nondiabetics, and t tests were used for continuous variables. Cox proportional hazards regression was used to examine the effects of diabetes (DM) on the survival times controlling for multiple covariates. Results: Of 48 733 ischemic stroke patients identified, 98% were male and 13 925 (25%) had DM. Mean age was similar between DM and non-DM (67.2 versus 67.5, P≤NS). Prevalence of DM among stroke subjects increased from 25% to 31%. Charlson index >2 was much higher in DM (68.2% versus 47.9%, P<0.001). Mortality at 60 days and 1 year was similar in both groups (2.9 versus 2.7%, P≤NS; 12.6 versus 13.1, P≤NS). Kaplan-Meier survival plot showed that DM had shorter long term survival time (log-rank, P<0.001). Multivariate Cox proportional hazards regression showed a higher risk of death for diabetics (HR≤1.15, 95% CI 1.11 to 1.19, P<0.001). Conclusion: Despite greater comorbidity, postacute ischemic stroke mortality at 60 days and 1 year is not different between subjects with and without DM. Long term mortality after stroke is much lower among DM than that reported in older studies.

AB - Background and Purpose: Recent data on stroke mortality in diabetics in the United States is lacking. We investigated trends in diabetes prevalence and stroke morality among diabetics in a large veteran cohort. Methods: The Patient Treatment File was used to identify all patients discharged from any Veterans hospital between October 1990 and September 1997 with a diagnosis of ischemic stroke (ICD-9-CM codes 434, 436) listed as primary diagnosis. Demographic, morbidity, and mortality data were recorded. Chi-square tests were used to examine differences between diabetics and nondiabetics, and t tests were used for continuous variables. Cox proportional hazards regression was used to examine the effects of diabetes (DM) on the survival times controlling for multiple covariates. Results: Of 48 733 ischemic stroke patients identified, 98% were male and 13 925 (25%) had DM. Mean age was similar between DM and non-DM (67.2 versus 67.5, P≤NS). Prevalence of DM among stroke subjects increased from 25% to 31%. Charlson index >2 was much higher in DM (68.2% versus 47.9%, P<0.001). Mortality at 60 days and 1 year was similar in both groups (2.9 versus 2.7%, P≤NS; 12.6 versus 13.1, P≤NS). Kaplan-Meier survival plot showed that DM had shorter long term survival time (log-rank, P<0.001). Multivariate Cox proportional hazards regression showed a higher risk of death for diabetics (HR≤1.15, 95% CI 1.11 to 1.19, P<0.001). Conclusion: Despite greater comorbidity, postacute ischemic stroke mortality at 60 days and 1 year is not different between subjects with and without DM. Long term mortality after stroke is much lower among DM than that reported in older studies.

KW - Diabetes

KW - Mortality

KW - Stroke

UR - http://www.scopus.com/inward/record.url?scp=54049084576&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=54049084576&partnerID=8YFLogxK

U2 - 10.1161/STROKEAHA.108.517441

DO - 10.1161/STROKEAHA.108.517441

M3 - Article

C2 - 18658031

AN - SCOPUS:54049084576

VL - 39

SP - 2727

EP - 2731

JO - Stroke

JF - Stroke

SN - 0039-2499

IS - 10

ER -