Stein Laura K, Kornspun Alana, Erdman John, Dhamoon Mandip S
Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, USA,
Department of Medicine, University of North Carolina Hospitals, Chapel Hill, North Carolina, USA.
Cerebrovasc Dis Extra. 2020;10(2):94-104. doi: 10.1159/000509454. Epub 2020 Aug 27.
Rates of depression after ischemic stroke (IS) and myocardial infarction (MI) are significantly higher than in the general population and associated with morbidity and mortality. There is a lack of nationally representative data comparing depression and suicide attempt (SA) after these distinct ischemic vascular events.
The 2013 Nationwide Readmissions Database contains >14 million US admissions for all payers and the uninsured. Using International Classification of Disease, 9th Revision, Clinical Modification Codes, we identified index admission with IS (n = 434,495) or MI (n = 539,550) and readmission for depression or SA. We calculated weighted frequencies of readmission. We performed adjusted Cox regression to calculate hazard ratio (HR) for readmission for depression and SA up to 1 year following IS versus MI. Analyses were stratified by discharge home versus elsewhere.
Weighted depression readmission rates were higher at 30, 60, and 90 days in patients with IS versus MI (0.04%, 0.09%, 0.12% vs. 0.03%, 0.05%, 0.07%, respectively). There was no significant difference in SA readmissions between groups. The adjusted HR for readmission due to depression was 1.49 for IS versus MI (95% CI 1.25-1.79, p < 0.0001). History of depression (HR 3.70 [3.07-4.46]), alcoholism (2.04 [1.34-3.09]), and smoking (1.38 [1.15-1.64]) were associated with increased risk of depression readmission. Age >70 years (0.46 [0.37-0.56]) and discharge home (0.69 [0.57-0.83]) were associated with reduced hazards of readmission due to depression.
IS was associated with greater hazard of readmission due to depression compared to MI. Patients with a history of depression, smoking, and alcoholism were more likely to be readmitted with depression, while advanced age and discharge home were protective. It is unclear to what extent differences in type of ischemic tissue damage and disability contribute, and further investigation is warranted.
缺血性脑卒中（IS）和心肌梗死（MI）后抑郁症的发病率显著高于普通人群，且与发病率和死亡率相关。目前缺乏全国代表性数据来比较这两种不同缺血性血管事件后的抑郁症和自杀未遂（SA）情况。
2013年全国再入院数据库包含超过1400万美国所有支付方和未参保者的入院记录。使用国际疾病分类第九版临床修订版编码，我们确定了IS（n = 434,495）或MI（n = 539,550）的首次入院以及因抑郁症或SA的再入院情况。我们计算了再入院的加权频率。我们进行了校正Cox回归分析，以计算IS与MI后1年内因抑郁症和SA再入院的风险比（HR）。分析按出院回家与其他情况进行分层。
IS患者在30、60和90天时的抑郁症加权再入院率高于MI患者（分别为0.04%、0.09%、0.12%对0.03%、0.05%、0.07%）。两组间SA再入院率无显著差异。IS与MI相比，因抑郁症再入院的校正HR为1.49（95%CI 1.25 - 1.79，p < 0.0001）。抑郁症病史（HR 3.70 [3.07 - 4.46]）、酗酒（2.04 [1.34 - 3.09]）和吸烟（1.38 [1.15 - 1.64]）与抑郁症再入院风险增加相关。年龄>70岁（0.46 [0.37 - 0.56]）和出院回家（0.69 [0.57 - 0.83]）与因抑郁症再入院风险降低相关。
与MI相比，IS与因抑郁症再入院的风险更高相关。有抑郁症、吸烟和酗酒病史的患者更有可能因抑郁症再次入院，而高龄和出院回家具有保护作用。目前尚不清楚缺血性组织损伤类型和残疾程度的差异在多大程度上起作用，需要进一步研究。
