Policardo Laura, Seghieri Giuseppe, Anichini Roberto, De Bellis Alessandra, Franconi Flavia, Francesconi Paolo, Del Prato Stefano, Mannucci Edoardo
Agenzia Regionale Sanità, Florence, Italy.
Diabetes Metab Res Rev. 2015 Mar;31(3):280-6. doi: 10.1002/dmrr.2607. Epub 2014 Nov 18.
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.
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.
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.
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.
西方人群中缺血性中风的发病率及相关住院死亡率正在下降，而作为缺血性中风已知危险因素的糖尿病患病率却在逐步上升。本研究旨在评估糖尿病对缺血性中风住院治疗及缺血性中风后住院死亡率的影响。
在一个包含意大利托斯卡纳常住居民2004年至2011年所有住院病例的数据库中，识别出诊断为缺血性中风的出院病例。通过特定药物处方、官方认证或既往医院诊断来确定糖尿病病例。分别计算有糖尿病和无糖尿病的受试者按性别和年龄组划分的年度缺血性中风发病率及相关住院死亡率。
共识别出65165例诊断为缺血性中风的出院病例。糖尿病与中风风险增加相关，优势比（95%置信区间）：男性为1.31（1.28 - 1.34），女性为1.24（1.21 - 1.37）。与男性相比，糖尿病女性缺血性中风后的住院死亡风险更高（优势比：1.32；1.06 - 1.64），而在非糖尿病受试者中，性别之间无差异。除≤70岁女性外，非糖尿病受试者的缺血性中风发病率有所下降；住院死亡率也有类似下降。相反，在糖尿病患者中，老年人（>70岁）的缺血性中风年发病率上升了3%，年死亡率趋势保持不变。
在过去十年中，无糖尿病者的缺血性中风发病率及相关住院死亡率下降，而高龄糖尿病患者中则上升。糖尿病女性与男性相比，住院死亡风险更高。
