Sex Differences in Outcomes after Stroke in Patients with Diabetes in Ontario, Canada

Dhamoon, Mandip S.; Liang, John; Zhou, Limei; Stamplecoski, Melissa; Kapral, Moira K.; Shah, Baiju R.

doi:10.1016/j.jstrokecerebrovasdis.2017.08.028

Cited by 15 publications

(27 citation statements)

References 34 publications

(57 reference statements)

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“…Our results differ from a German IS study that found no DM-related mortality differences for women but diabetic men with IS had lower short-term mortality, compared with non-diabetic men; notably, this effect did not persist after a year ( 16 ). A recent Canadian study showed lower mortality in DM women ( 17 ). However, neither study adjusted for stroke severity and disability previous to the index stroke.…”

Section: Discussionmentioning

confidence: 98%

“…A recent meta-analysis has estimated that women with DM have a 27% greater risk of stroke than men with DM ( 10 ), and some studies suggest that they have worse survival and functional outcome than men ( 11 – 14 ). Other studies, however, have found increased mortality for both women and men with diabetes ( 15 ), a time-dependent mortality risk only for DM men ( 16 ), and lower adjusted mortality in DM women than in men ( 17 ) The reasons for these sex differences are unknown, and the majority of the research has focused on comparing men and women with DM, with little information about how sex can influence the short- and long-term impact of DM on post-IS prognosis. On the other hand, many of these studies are unadjusted ( 12 , 17 ) or adjusted only by age and vascular risk factors ( 14 – 17 ) or previous treatments ( 15 , 16 ) without taking into account two of the most important predictors of mortality: previous disability and stroke severity.…”

Section: Introductionmentioning

confidence: 95%

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Interaction of Sex and Diabetes on Outcome After Ischemic Stroke

et al. 2018

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BackgroundThe relationship between ischemic stroke (IS), diabetes mellitus (DM), and sex is intriguing. The aim of this study was to assess the effect modification of sex in the association between DM and short- and long-term disability and mortality in first-ever IS patients.MethodsIn a retrospective, observational, hospital-based study of a prospective series including first-ever IS patients from January 2006 until July 2011, differences in 3-month and 5-year mortality, and disability between diabetic and non-diabetic patients [modified Rankin Scale (mRS) from 3 to 5] were analyzed by sex.ResultsIn total, 933 patients (36.3% with DM, 50.5% women) were included. Overall 3-month and 5-year mortality were 150 (16.1%) and 407 (44.1%), respectively. Adjusted for age, previous mRS, and stroke severity, patients with DM had significantly higher 3-month disability [hazard ratio (HR): 1.49 (95% confidence interval (CI): 1.39–1.70), p < 0.0001], 5-year disability [HR: 1.41 (95% CI: 1.07–1.86), p = 0.015], and 5-year mortality [HR: 1.48 (95% CI: 1.20–1.81), p < 0.0001], compared with the non-DM group. Compared with non-DM women, women with diabetes had worse 3-month disability [HR: 1.81 (95% CI: 1.33–2.46), p < 0.0001] and 5-year mortality [HR: 1.72 (95% CI: 1.30–2.20), p < 0.0001], and a trend for 5-year disability [HR: 1.40 (95% CI: 0.99–2.09), p = 0.057]. In men, DM had an effect on 3-month disability [HR: 1.45 (95% CI: 1.07–1.96), p = 0.018], a trend for 5-year disability [HR: 1.43 (95% CI: 0.94–2.19), p = 0.096], but no clear effect on 5-year mortality [HR: 1.22 (95% CI: 0.91–1.65), p = 0.186].ConclusionSex has a modifier effect on mortality in first-ever IS diabetic patients. Long-term mortality is increased in diabetic women compared with non-diabetic women, a difference not observed in men.

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Section: Discussionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 95%

Interaction of Sex and Diabetes on Outcome After Ischemic Stroke

et al. 2018

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“…Nevertheless, women with diabetes had a higher risk of AKI than men. Previous studies have yielded equivocal results regarding the interaction between sex and diabetes mellitus in stroke outcomes, which could be due to ethnic differences between populations [21][22][23]. More research is needed to clearly establish the relationship between diabetes, sex and stroke outcomes in different populations.…”

Section: Discussionmentioning

confidence: 99%

Impact of Diabetes on Complications, Long Term Mortality and Recurrence in 608,890 Hospitalised Patients with Stroke

Szlachetka

Pana

Tiamkao

et al. 2020

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Background: Patients with diabetes mellitus (DM) have been found to be at an increased risk of suffering a stroke. However, research on the impact of DM on stroke outcomes is limited. Objectives: We aimed to examine the influence of DM on outcomes in ischaemic (IS) and haemorrhagic stroke (HS) patients. Methods: We included 608,890 consecutive stroke patients from the Thailand national insurance registry. In-hospital mortality, sepsis, pneumonia, acute kidney injury (AKI), urinary tract infection (UTI) and cardiovascular events were evaluated using logistic regressions. Long-term analysis was performed on first-stroke patients with a determined pathology (n = 398,663) using Royston-Parmar models. Median follow-ups were 4.21 and 4.78 years for IS and HS, respectively. All analyses were stratified by stroke sub-type. Results: Mean age (SD) was 64.3 (13.7) years, 44.9% were female with 61% IS, 28% HS and 11% undetermined strokes. DM was associated with in-hospital death, pneumonia, sepsis, AKI and cardiovascular events (odds ratios ranging from 1.13-1.78, p < 0.01) in both stroke types. In IS, DM was associated with long-term mortality and recurrence throughout the follow-up: HR max (99% CI) at t = 4108 days: 1.54 (1.27, 1.86) and HR (99% CI) = 1.27(1.23,1.32), respectively. In HS, HR max (t = 4108 days) for long-term mortality was 2.10 (1.87, 2.37), significant after day 14 post-discharge. HR max (t = 455) for long-term recurrence of HS was 1.29 (1.09, 1.53), significant after day 116 post-discharge. Conclusions: Regardless of stroke type, DM was associated with in-hospital death and complications, long-term mortality and stroke recurrence.

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“…It is interesting to note that the type of stroke did not lead to a worse 1 and 5 year survival for those who survived the first 28 days after the stroke, although having assessed all cases of stroke, we noticed that the hemorrhagic and subarachnoid type of stroke significantly led to higher mortality. It can be argued that long-term survival was more influenced not by clinical signs or complications, but by chronic concomitant illness, bad control of stroke risk factors or harmful lifestyle [43, 46, 47].…”

Section: Discussionmentioning

confidence: 99%

Long-term survival after stroke in Lithuania: Data from Kaunas population-based stroke registry

Radišauskas

Tamošiūnas

Krančiukaitė-Butylkinienė

et al. 2019

PLoS ONE

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Background There is a lack of reliable epidemiological data on long-term survival trends of first-ever stroke patients in Lithuanian population. Aims To evaluate trends in long-term survival after stroke and to determine the influence of some sociodemographic and lifestyle factors, time and subtype of stroke, and stroke care on survival. Methods All stroke events included in Kaunas stroke register database were ascertained and validated according to the standardized criteria outlined by the WHO MONICA Project. The study included all patients in Kaunas (Lithuania) city aged 25 to 64 years who experienced a stroke between 1986 and 2011. Death time was confirmed by the Office for National Death Statistics. Estimates of stroke long-term survival data and factors influencing survival changes were made by applying the Kaplan-Meier and Cox regression analysis. Results During the study period, 4,129 persons aged 25–64 years suffered from a first-ever stroke: 2,215 (53.6%) of them were men and 1,914 (46.4%)—women. Ischemic stroke was significantly more frequent in males than in females (80.6% and 78.6%, respectively, p<0.05) and subarachnoid hemorrhage was more common in women than in men (9.0% and 7.0% respectively, p <0.05). Of all first-ever stroke patients, 3,272 (79.2%) survived 1 year and 2,905 (70.4%) survived 5 years after stroke onset. The 1- and 5-years survival rate after a first-ever stroke in women was significantly higher as compared with that in men (Log-rank test p = 0.0001). The older (55–64 year) persons had poorer 1-year and 5-years survival rate as compared with persons in the younger (25–54 years) age group (Log-rank test p = 0.0001). Among persons with a first-ever stroke who had their stroke in 2007–2011, 1- and 5-year survival rate was higher compared with that in persons who had had a stroke in 1986–1990 and in 1997–2001 (Log-rank test p = 0.0001). The persons with a first-ever ischemic stroke had a better chance to survive first 1- and 5-years after stroke compared with persons who had intracerebral or subarachnoid haemorrhage. Only female gender was associated with higher 1- and 5-year survival rate after first-ever stroke. The older age, previous myocardial infarction and diabetes mellitus were associated with lower 1- and 5-year survival rate after first-ever stroke. Conclusions This population-based study of patients with first-ever stroke demonstrated that the long-term survival was better in women than men, and improved significantly in both men and women during the past decade. Long-term survival was better of those with first-ever ischemic stroke and of younger age– 25 to 54 years.

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Sex Differences in Outcomes after Stroke in Patients with Diabetes in Ontario, Canada

Cited by 15 publications

References 34 publications

Interaction of Sex and Diabetes on Outcome After Ischemic Stroke

Interaction of Sex and Diabetes on Outcome After Ischemic Stroke

Impact of Diabetes on Complications, Long Term Mortality and Recurrence in 608,890 Hospitalised Patients with Stroke

Long-term survival after stroke in Lithuania: Data from Kaunas population-based stroke registry

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