Time-Dependent Impact of Diabetes on Mortality in Patients With Stroke
Open Access
- 14 August 2012
- journal article
- Published by American Diabetes Association in Diabetes Care
- Vol. 35 (9), 1868-1875
- https://doi.org/10.2337/dc11-2159
Abstract
OBJECTIVE To estimate the impact of diabetes on mortality in patients after first stroke event. RESEARCH DESIGN AND METHODS Using claims data from a nationwide statutory health insurance fund (Gmünder ErsatzKasse), we assessed all deaths in a cohort of 5,757 patients with a first stroke between 2005 and 2007 (69.3% male, mean age 68.1 years, 32.2% with diabetes) up to 2009. By use of Cox regression, we estimated time-dependent hazard ratios (HRs) to compare patients with and without diabetes stratified by sex. RESULTS The cumulative 5-year mortality was 40.0 and 54.2% in diabetic men and women, and 32.3 and 38.1% in their nondiabetic counterparts, respectively. In males, mortality was significantly lower in diabetic compared with nondiabetic patients in the first 30 days (multiple-adjusted HR 0.67 [95% CI 0.53–0.84]). After approximately a quarter of a year, the diabetes risk increased, yielding crossed survival curves. Later on, mortality risk tended to be similar in diabetic and nondiabetic men (1–2 years: 1.42 [1.09–1.85]; 3–5 years: 1.00 [0.67–1.41]; time dependency of diabetes, P = 0.008). In women, the pattern was similar; however, time dependency was not statistically significant (P = 0.89). Increasing age, hemorrhagic stroke, renal failure (only in men), levels of care dependency, and number of prescribed medications were significantly associated with mortality. CONCLUSIONS We found a time-dependent mortality risk of diabetes after first stroke in men. Possible explanations may be type of stroke or earlier and more intensive treatment of risk factors in diabetic patients.Keywords
This publication has 39 references indexed in Scilit:
- Time-Dependent Impact of Diabetes on Mortality in Patients After Major Lower Extremity AmputationDiabetes Care, 2011
- Standards of Medical Care in Diabetes—2011Diabetes Care, 2011
- Selection effects may account for better outcomes of the German Disease Management Program for type 2 diabetesBMC Health Services Research, 2010
- Multimorbidity Patterns in the Elderly: A New Approach of Disease Clustering Identifies Complex Interrelations between Chronic ConditionsPLOS ONE, 2010
- Race- and Sex-Specific Associations of Obesity Measures With Ischemic Stroke Incidence in the Atherosclerosis Risk in Communities (ARIC) StudyStroke, 2010
- The Impact of Body Mass Index on Mortality After StrokeStroke, 2009
- Incidence and Risk Factors for Stroke in American IndiansCirculation, 2008
- Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): Explanation and ElaborationPLoS Medicine, 2007
- Out-of-hospital delays in patients with acute strokeAnnals of Emergency Medicine, 2004
- Proportional hazards tests and diagnostics based on weighted residualsBiometrika, 1994