Department of Medicine, Division of General Internal Medicine, University of Toronto, Toronto, Ontario, Canada
ICES, Toronto, Ontario, Canada.
BMJ Open. 2021 Jun 10;11(6):e044766. doi: 10.1136/bmjopen-2020-044766.
Schizophrenia is associated with an increased risk of death following stroke; however, the magnitude and underlying reasons for this are not well understood.
To determine the association between schizophrenia and stroke case fatality, adjusting for baseline characteristics, stroke severity and processes of care.
Retrospective cohort study used linked clinical and administrative databases.
All acute care institutions (N=152) in the province of Ontario, Canada.
All patients (N=52 473) hospitalised with stroke between 1 April 2002 and 31 March 2013 and included in the Ontario Stroke Registry. Those with schizophrenia (n=612) were identified using validated algorithms.
We compared acute stroke care in those with and without schizophrenia and used Cox proportional hazards models to examine the association between schizophrenia and mortality, adjusting for demographics, comorbidity, stroke severity and processes of care.
Compared with those without schizophrenia, people with schizophrenia were less likely to undergo thrombolysis (10.1% vs 13.4%), carotid imaging (66.3% vs 74.0%), rehabilitation (36.6% vs 46.6% among those with disability at discharge) or be treated with antihypertensive, lipid-lowering or anticoagulant therapies. After adjustment for age and other factors, schizophrenia was associated with death from any cause at 1 year (adjusted HR (aHR) 1.33, 95% CI 1.14 to 1.54). This was mainly attributable to early deaths from stroke (aHR 1.47, 95% CI 1.20 to 1.80, with survival curves separating in the first 30 days), and the survival disadvantage was particularly marked in those aged over 70 years (1-year mortality 46.9% vs 35.0%).
Schizophrenia is associated with increased stroke case fatality, which is not fully explained by stroke severity, measurable comorbid conditions or processes of care. Future work should focus on understanding this mortality gap and on improving acute stroke and secondary preventive care in people with schizophrenia.
精神分裂症与中风后死亡风险增加相关；然而，其严重程度和潜在原因尚不清楚。
确定精神分裂症与中风病死率之间的关联，同时调整基线特征、中风严重程度和治疗过程。
回顾性队列研究使用了临床和行政数据库。
加拿大安大略省所有急性护理机构。
2002 年 4 月 1 日至 2013 年 3 月 31 日期间因中风住院并纳入安大略中风登记处的所有患者（N=52473）。使用经过验证的算法确定患有精神分裂症的患者（n=612）。
我们比较了有和没有精神分裂症的患者的急性中风护理情况，并使用 Cox 比例风险模型，在校正人口统计学、合并症、中风严重程度和治疗过程后，研究精神分裂症与死亡率之间的关联。
与没有精神分裂症的患者相比，精神分裂症患者接受溶栓治疗的可能性较小（10.1%比 13.4%），接受颈动脉成像的可能性较小（66.3%比 74.0%，出院时存在残疾的患者），接受降压、降脂或抗凝治疗的可能性较小。在校正年龄和其他因素后，精神分裂症与任何原因导致的 1 年死亡相关（调整后的 HR（aHR）1.33，95%CI 1.14 至 1.54）。这主要归因于中风早期死亡（aHR 1.47，95%CI 1.20 至 1.80，生存曲线在第 30 天前分离），并且在 70 岁以上的患者中，生存劣势尤为明显（1 年死亡率 46.9%比 35.0%）。
精神分裂症与中风病死率增加相关，而这种相关性不能完全用中风严重程度、可测量的合并症或治疗过程来解释。未来的工作应集中于了解这一死亡率差距，并改善精神分裂症患者的急性中风和二级预防护理。
