Background

Diabetes is a major risk factor for ischemic stroke and may affect post-stroke survival. Previous large scale studies of long-term post-stroke survival are limited and most of them excluded older patients from the study population.

Objectives

To compare the risk factors and sociodemographic characteristics between first ischemic stroke cases with and without diabetes and to assess the mortality risk associated with diabetes.

Methods

Using population-based National Stroke Registry in Israel, all patients hospitalized for a first event of ischemic stroke between the years 2014-2018 were followed for all-cause mortality. Chi-square analysis was used to compare the differences in risk factors, sociodemographic profile and cumulative mortality between patients with and without diabetes. Cox proportional hazards models were used to estimate the hazard ratio for mortality in selected timeframes.

Results

Among 41,639 patients with a first event of ischemic stroke, 44.5% were previously diagnosed with diabetes. Diabetic patients were more likely to be males, members of the Arab ethnic group, with lower socioeconomic status and a higher prevalence of cardiovascular comorbidities, anemia, leukocytosis and abnormal kidney function. Diabetes was associated with a higher mortality risk in the first year and long term, but not in the first month following stroke. Diabetes-associated mortality risk interacted with time and age, was higher in younger age and increased with time.

Conclusions

Our findings suggest that diabetes is associated with a higher prevalence of comorbidities among patients with first ischemic stroke and with a higher risk for mortality in the mid and long term, which is more profound in younger age.

中文翻译：

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首次中风幸存者的糖尿病相关死亡风险随着时间的推移而增加 - 以色列国家中风登记处的调查结果

背景

糖尿病是缺血性卒中的主要危险因素，可能会影响卒中后的存活率。以前对中风后长期生存的大规模研究是有限的，其中大多数将老年患者排除在研究人群之外。

目标

比较合并和不合并糖尿病的首发缺血性卒中病例的危险因素和社会人口学特征，并评估与糖尿病相关的死亡风险。

方法

使用以色列基于人群的国家卒中登记处，对 2014-2018 年间因首次发生缺血性卒中而住院的所有患者进行全因死亡率跟踪。卡方分析用于比较糖尿病患者和非糖尿病患者在危险因素、社会人口学特征和累积死亡率方面的差异。Cox 比例风险模型用于估计选定时间范围内死亡率的风险比。

结果

在首次发生缺血性卒中的 41,639 名患者中，44.5% 的患者既往被诊断为糖尿病。糖尿病患者更可能是男性、阿拉伯族裔成员，社会经济地位较低，心血管合并症、贫血、白细胞增多和肾功能异常的患病率较高。糖尿病与第一年和长期较高的死亡风险相关，但在中风后的第一个月则没有。糖尿病相关的死亡风险与时间和年龄相互作用，在年轻时更高，随着时间的推移而增加。

结论

我们的研究结果表明，糖尿病与首次缺血性卒中患者的合并症患病率较高有关，并且在中长期死亡率较高，这在年轻时更为严重。