International UNESCO Center for Health-Related Basic Sciences and Human Nutrition, Mashhad University of Medical Sciences, Mashhad, Iran.
Psychiatry and Behavioural Sciences Research Centre, Mashhad University of Medical Sciences, Mashhad, Iran.
Neuroepidemiology. 2021;55(3):171-179. doi: 10.1159/000514401. Epub 2021 May 11.
Little is known regarding long-term stroke outcomes in patients with substance use disorder (SUD). Based on anecdotal data, some individuals use illicit drugs, particularly opioids, in an attempt to reduce stroke mortality, disability, or recurrence. This study is aimed to assess the effect of SUD on stroke outcomes.
Patients were recruited from the Mashhad Stroke Incidence Study, a population-based study of stroke in Iran. For a period of 1 year, all patients with first-ever stroke (FES) were recruited and then followed up for the next 5 years. Disability and functional dependency were defined using modified Rankin Scale (>2) and Barthel Index (<60), respectively. We compared the cumulative rates of mortality in follow-up points using the log-rank test. We used multivariable logistic, Cox regression and competing risk models to assess adjusted hazard ratio (aHR) with 95% confidence interval (CI) of stroke disability, functional dependency, mortality, and recurrence among those with a history of SUD.
595 FES patients (mean age of 64.6 ± 14.8 years) were recruited in this study. Eighty-one (13.6%) were current substance users, including opium (n = 68), naswar (n = 5, 6.1%), hashish (n = 1), heroin (n = 1), and (n = 7) others. The frequency of vascular risk factors was similar between the SUD and non-SUD groups, except for a higher rate of cigarette smoking in the SUD group (p < 0.001). After adjusting for various sociodemographic variables, vascular risk factors, and the severity of stroke at admission, SUD increased the 3-month (aHR: 1.60, CI: 1.01-2.49), 1-year (aHR: 1.73, CI: 1.20-2.65), and 5-year (aHR: 1.72, CI: 1.23-2.35) poststroke mortality risk. We did not observe a significant change in the risk of stroke recurrence, disability, and functional dependency in those with a history of SUD.
SUD increased the hazard ratio of stroke mortality with no effect on the disability rate. The public should be advised about the potential harm of substance abuse.
关于有物质使用障碍（SUD）的患者的长期卒中结局，我们知之甚少。根据传闻数据，一些人使用非法药物，特别是阿片类药物，试图降低卒中死亡率、残疾或复发率。本研究旨在评估 SUD 对卒中结局的影响。
患者从伊朗的一项基于人群的卒中研究——马什哈德卒中发生率研究中招募。在 1 年期间，招募所有首次卒中（FES）患者，然后在接下来的 5 年内进行随访。使用改良 Rankin 量表（>2）和 Barthel 指数（<60）分别定义残疾和功能依赖。我们使用对数秩检验比较随访点的死亡率累积率。我们使用多变量逻辑、Cox 回归和竞争风险模型评估有 SUD 史的患者的卒中残疾、功能依赖、死亡率和复发的调整后危险比（aHR）及其 95%置信区间（CI）。
本研究共招募了 595 例 FES 患者（平均年龄 64.6±14.8 岁）。81 例（13.6%）为当前物质使用者，包括阿片类药物（n=68）、鼻烟（n=5，6.1%）、大麻（n=1）、海洛因（n=1）和（n=7）其他药物。SUD 组的血管危险因素频率与非 SUD 组相似，除了 SUD 组的吸烟率较高（p<0.001）。在校正各种社会人口统计学变量、血管危险因素和入院时卒中严重程度后，SUD 增加了 3 个月（aHR：1.60，CI：1.01-2.49）、1 年（aHR：1.73，CI：1.20-2.65）和 5 年（aHR：1.72，CI：1.23-2.35）的卒中后死亡率风险。我们没有观察到有 SUD 史的患者卒中复发、残疾和功能依赖风险的显著变化。
SUD 增加了卒中死亡的危险比，但对残疾率没有影响。应告知公众滥用物质的潜在危害。
