Tong X, Yang Q, Gillespie C, Merritt R K
Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, USA.
Austin J Cardiovasc Dis Atheroscler. 2024 Mar 5;11(1):1-6.
COVID-19 is associated with increased risk of Acute Ischemic Stroke (AIS). The present study examined the impact of prior COVID-19 diagnoses on overall survival among older AIS patients.
We included 250,079 Medicare Fee-For-Service (FFS) beneficiaries aged ≥65 years with AIS hospitalizations from 04/01/2020 through 12/31/2021. Overall survival was defined as the time from date of AIS hospitalization to date of death, or through end of follow-up on 03/31/2023. We used a Cox proportional hazard model to examine the association between history of COVID-19 and overall survival among AIS beneficiaries, and we obtained age, sex, race/ethnicity, Social Vulnerability Index (SVI), National Institutes of Health Stroke Scale score, and comorbidity-adjusted survival estimates.
Among 250,079 Medicare FFS beneficiaries with AIS, 98,327 (39.3%) died during a median of 590 days (IQR, 169-819 days) of follow-up with a total of 365,606 person-years. The 1-year adjusted overall survival was 62.0%, 67.4%, and 68.8% in beneficiaries with hospitalized COVID-19, with non-hospitalized COVID-19 and no COVID-19 respectively (p<0.001). Compared to AIS without history of COVID-19, the adjusted mortality hazard ratios were 1.30 (95% CI, 1.26-1.34) and 1.06 (95% CI, 1.03-1.10) for those with a history of hospitalized and non-hospitalized COVID-19, respectively. The patterns of overall survival by COVID-19 history were largely consistent across age groups, sex, race/ethnicity, and SVI groups.
A history of COVID-19 diagnoses, especially with a history of severe COVID-19, was associated with a significantly higher risk of all-cause mortality among Medicare FFS beneficiaries hospitalized with AIS.
新冠病毒病（COVID-19）与急性缺血性卒中（AIS）风险增加相关。本研究探讨既往COVID-19诊断对老年AIS患者总体生存的影响。
我们纳入了250,079名年龄≥65岁的医疗保险按服务收费（FFS）受益人，他们在2020年4月1日至2021年12月31日期间因AIS住院。总体生存定义为从AIS住院日期到死亡日期的时间，或至2023年3月31日随访结束。我们使用Cox比例风险模型来研究COVID-19病史与AIS受益人的总体生存之间的关联，并获得了年龄、性别、种族/族裔、社会脆弱性指数（SVI）、美国国立卫生研究院卒中量表评分以及合并症调整后的生存估计值。
在250,079名患有AIS的医疗保险FFS受益人中，98,327人（39.3%）在中位590天（四分位间距，169 - 819天）的随访期间死亡，总人年数为365,606人年。有住院COVID-19、非住院COVID-19和无COVID-19的受益人1年调整后的总体生存率分别为62.0%、67.4%和68.8%（p<0.001）。与无COVID-19病史的AIS相比，有住院COVID-19病史和非住院COVID-19病史者调整后的死亡风险比分别为1.30（95%置信区间，1.26 - 1.34）和1.06（95%置信区间，1.03 - 1.10）。按COVID-19病史划分的总体生存模式在各年龄组、性别、种族/族裔和SVI组中基本一致。
COVID-19诊断史，尤其是重症COVID-19病史，与因AIS住院的医疗保险FFS受益人全因死亡风险显著升高相关。
