Effect of diabetes on hospitalization for ischemic stroke and related in-hospital mortality: a study in Tuscany, Italy, over years 2004-2011

• Published in: Diabetes/metabolism research and reviews 2015-03, Vol.31 (3), p.280-286
• Main Authors: Policardo, Laura, Seghieri, Giuseppe, Anichini, Roberto, De Bellis, Alessandra, Franconi, Flavia, Francesconi, Paolo, Del Prato, Stefano, Mannucci, Edoardo
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; annual incidence; Confidence intervals; Diabetes; Diabetes Mellitus - physiopathology; Female; Follow-Up Studies; Heart attacks; Hospital Mortality - trends; Hospitalization; Hospitalization - statistics & numerical data; Humans; in-hospital mortality; Incidence; ischemic stroke; Italy - epidemiology; Male; Middle Aged; Mortality; Older people; Prognosis; Retrospective Studies; Risk Factors; sex; Stroke; Stroke - epidemiology; Time Factors; Young Adult
• ISSN: 1520-7552; 1520-7560
• DOI: 10.1002/dmrr.2607

Background Incidence of ischemic stroke and associated in‐hospital mortality is decreasing in Western populations, while the prevalence of diabetes, a well‐known risk factor for ischemic stroke, is progressively rising. This study was aimed at evaluating the effect of diabetes on ischemic stroke hospitalization and in‐hospital mortality after ischemic stroke. Methods Discharges with diagnosis of ischemic stroke were identified in a database containing all hospitalizations of resident population of Tuscany, Italy, over years 2004–2011. Cases with diabetes were identified through specific drug prescriptions, official certifications or previous hospital diagnosis. Rates of annual ischemic stroke incidence and related in‐hospital mortality were separately calculated for gender and age class, in subjects with and without diabetes. Results Sixty‐five thousand one hundred sixty‐five hospital discharges with ischemic stroke diagnosis were identified. Diabetes was associated with increased risk of stroke odds ratio(95% confidence interval):1.31(1.28–1.34) in men and 1.24(1.21–1.37) in women. Diabetic women, compared with men, had a higher in‐hospital mortality risk after ischemic stroke (odds ratio:1.32; 1.06–1.64), whereas in non‐diabetic subjects, there was no difference between genders. Incidence of ischemic stroke has declined in non‐diabetic subjects, except for women aged ≤70 years; a similar reduction was observed for in‐hospital mortality. Among diabetic patients, conversely, annual incidence of ischemic stroke rose by 3% in the elderly people (>70 years), and annual mortality trend remained unchanged. Conclusions In the last decade, the incidence of ischemic stroke and of related in‐hospital mortality declined in persons without diabetes, while increasing among diabetic patients of advanced age. Women with diabetes, compared with men, had a higher in‐hospital mortality risk. Copyright © 2014 John Wiley & Sons, Ltd.