Department of Neurosurgery, Hualien Tzu Chi General Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan; College of Medicine, Tzu Chi University, Hualien, Taiwan.
Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan; College of Medicine, China Medical University, Taichung, Taiwan.
Atherosclerosis. 2019 May;284:148-152. doi: 10.1016/j.atherosclerosis.2019.03.007. Epub 2019 Mar 13.
We aimed to determine whether patients with post-stroke dementia (PSD) have increased mortality risk in Taiwan.
We included ≥40-year-old patients who received a stroke diagnosis between 2000 and 2012 from a subset of the National Health Insurance Research Database of Taiwan. These patients were divided into PSD (International Classification of Diseases, Ninth Revision, Clinical Modification codes 290, 294.1, and 331.0) and post-stroke non-dementia (PSN) cohorts. Furthermore, we propensity score (PS) matched the PSD and PSN groups. PS was calculated through logistic regression to estimate the probability of stroke status assignment given the baseline variables, namely age, sex, and comorbidity. We calculated the adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) for death in the PSD and PSN cohorts after adjustments for age, sex, and comorbidities.
Overall incidence density rates of death were 148.7 and 106.7 per 1,000 person-years in the PSD and PSN PS-matched cohorts, with the aHR of 1.42 (95% CI = 1.34-1.50). Average hospital days increased by 9.03 days and frequency of medical visits increased by 15.8 times per year in the PSD cohort compared with the PSN cohort.
The subsequent mortality rate in patients with PSD is increased compared with those without PSD. Moreover, the average hospital days and frequency of medical visit are increased in patients with PSD. Our findings provide crucial information for clinicians and the government to improve survival of patients after stroke.
本研究旨在确定台湾地区卒中后痴呆（PSD）患者的死亡风险是否增加。
我们纳入了 2000 年至 2012 年从台湾全民健康保险研究数据库的一个子集中接受卒中诊断的年龄≥40 岁的患者。这些患者被分为 PSD（国际疾病分类，第 9 版，临床修正版代码 290、294.1 和 331.0）和卒中后非痴呆（PSN）队列。此外，我们进行了倾向评分（PS）匹配。PS 通过逻辑回归计算，用于估计在基线变量（年龄、性别和合并症）给定的情况下卒中状态分配的概率。我们计算了 PSD 和 PSN 队列在调整年龄、性别和合并症后死亡的调整后危险比（aHR）和 95%置信区间（CI）。
在 PSD 和 PSN 经 PS 匹配的队列中，全因死亡率的总体发生率密度分别为 148.7 和 106.7/1000 人年，aHR 为 1.42（95%CI=1.34-1.50）。与 PSN 队列相比，PSD 队列的平均住院天数增加了 9.03 天，每年就诊次数增加了 15.8 倍。
与无 PSD 的患者相比，PSD 患者的后续死亡率增加。此外，PSD 患者的平均住院天数和就诊次数增加。我们的研究结果为临床医生和政府提供了重要信息，以改善卒中后患者的生存。
