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Comorbidity and the increased mortality after hospitalization for stroke: a population‐based cohort study
Author(s) -
Corraini P.,
Szépligeti S. K.,
Henderson V. W.,
Ording A. G.,
HorváthPuhó E.,
Sørensen H. T.
Publication year - 2018
Publication title -
journal of thrombosis and haemostasis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.947
H-Index - 178
eISSN - 1538-7836
pISSN - 1538-7933
DOI - 10.1111/jth.13908
Subject(s) - comorbidity , stroke (engine) , medicine , cohort , population , mortality rate , intracerebral hemorrhage , cohort study , proportional hazards model , pediatrics , physical therapy , subarachnoid hemorrhage , mechanical engineering , environmental health , engineering
Essentials Comorbidity is prevalent in the stroke population and affects post‐stroke survival. A stroke patient cohort ( n = 201 691) and a general population cohort were followed for survival. Cancer and advanced renal/liver disease substantially increased one‐year stroke mortality. Tailoring stroke interventions according to comorbidity may reduce excess mortality.Summary Background Comorbidity is prevalent among stroke patients, affecting post‐stroke survival. It remains unknown whether comorbidity impacts post‐stroke mortality beyond the combined individual effects of stroke and comorbidity. Methods Using nationwide Danish databases, we performed a cohort study of 201 691 patients ≥ 18 years old with incident ischemic stroke, intracerebral or subarachnoid hemorrhage, or unspecified stroke during 1995–2012, and 992 942 adults from the general population, matched to stroke patients by birth year, sex and individual comorbidities in the Charlson Comorbidity Index. During up to 5 years of follow‐up, we computed standardized mortality rates ( SMR s) to assess interaction contrasts as a measure of excess mortality not explained by the additive effects of stroke and comorbidity acting alone. Results Five‐year post‐stroke mortality was 48%, corresponding to an SMR of 187 deaths per 1000 person‐years. During the 30‐day peak post‐stroke mortality ( SMR , 180 per 1000 person‐months), interaction with comorbidity represented 23%, 34% and 51% of post‐stroke mortality rates among patients with low (score = 1), moderate (score = 2–3) and high (score = 4+) comorbidity based on Charlson Comorbidity Index scores. The interaction accounted for 5% to 32% of subsequent 31–365‐day post‐stroke mortality rates, depending on comorbidity level. The interaction contrasts were most notable among comorbid patients with cancer, particularly with hematological or metastatic disease, followed by patients with moderate‐to‐severe liver or renal disease. Conclusion Comorbidity, notably cancer and advanced renal or liver disease, increased 1‐year mortality after stroke beyond the combined effects expected from either disease acting alone.