Background

Stroke-related mortality and disability-adjusted life years in adults younger than 65 have increased over the last decade. However, geographical differences in distributing these outcomes could reflect dissimilarity in determinants. Therefore, this cross-sectional study of secondary data from Chilean hospitals aims to analyze the association of sociodemographic and clinical factors with in-hospital case-fatality risk or acquired neurologic deficits (adverse outcomes) in inpatients aged 18 to 64 who experienced their first-ever stroke.

Methodology

Adjusted multivariable logistic regression models and interaction analysis using multiple imputation for missing data (4.99%) for 1,043 hospital discharge records from the UC-CHRISTUS Health Network International Refined Diagnosis Related Groups (IR-DRG) system database (2010–2021) were conducted.

Results

Mean age: 51.47 years (SD, 10.79); female: 39.60%. Stroke types: subarachnoid hemorrhage (SAH): 5.66%, intracerebral hemorrhage (ICH): 11.98%, and ischemic: 82.45%. Adverse outcomes: 25.22% (neurological deficit: 23.59%; in-hospital case-fatality risk: 1.63%). After adjusting for confounders, adverse outcomes were associated with stroke type (patients with ICH and ischemic stroke had higher odds than those with SAH), sociodemographic characteristics (age ≥ 40 years, residence in an area of the capital city other than the center-east, and coverage by public health insurance), and discharge diagnoses (obesity, coronary artery and chronic kidney diseases, and mood and anxiety disorders). For hypertension, women had higher odds of adverse outcomes.

Conclusions

In this predominantly Hispanic sample, modifiable social and health determinants are related to adverse short-term outcomes after a first-ever stroke. Longitudinal studies are needed to investigate the causal role of these factors.

中文翻译：

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与 65 岁以下成年人首次中风后不良短期结果相关的社会和健康决定因素

背景

过去十年中，65 岁以下成年人中风相关死亡率和伤残调整生命年有所增加。然而，这些结果分布的地理差异可能反映了决定因素的不同。因此，这项对智利医院二手数据的横断面研究旨在分析社会人口统计学和临床​​因素与 18 至 64 岁住院患者的院内病死风险或获得性神经功能缺损（不良后果）之间的关系。曾经中风。

方法

对来自 UC-CHRISTUS 健康网络国际精细诊断相关组 (IR-DRG) 系统数据库 (2010-2021) 的 1,043 份出院记录进行调整后的多变量逻辑回归模型和交互分析，使用多重插补缺失数据 (4.99%)。

结果

平均年龄：51.47 岁（SD，10.79）；女性：39.60%。中风类型：蛛网膜下腔出血（SAH）：5.66%，脑出血（ICH）：11.98%，缺血性：82.45%。不良后果：25.22%（神经功能缺损：23.59%；院内病死风险：1.63%）。调整混杂因素后，不良结果与卒中类型（ICH和缺血性卒中患者的发病率高于SAH患者）、社会人口学特征（年龄≥40岁、居住在中东部地区以外的首都地区）相关。 ，以及公共健康保险的覆盖范围），以及出院诊断（肥胖、冠状动脉和慢性肾脏疾病、情绪和焦虑障碍）。对于高血压，女性出现不良后果的几率更高。

结论

在这个以西班牙裔为主的样本中，可改变的社会和健康决定因素与首次中风后的短期不良后果有关。需要进行纵向研究来调查这些因素的因果作用。