Effect of diabetes on hospitalization for ischemic stroke and related in-hospital mortality. A study in Tuscany, Italy, over years 2004-2011

BACKGROUND: Incidence of ischemic stroke (IS) and associated in-hospital mortality are decreasing in Western populations, while the prevalence of diabetes, a well-known risk factor for IS, is progressively rising. Since whether the declining trend of IS occurs in diabetic patients as well is matter of debate, this study was aimed at evaluating the effect of diabetes on IS hospitalization and in-hospital mortality after IS.. METHODS: Discharges with diagnosis of IS were identified in a database containing all hospitalizations of resident population of Tuscany,Italy, over years 2004-2011. Cases with diabetes were identified through specific drug prescriptions, official certifications, or previous hospital diagnosis. Rates of annual IS incidence and related in-hospital mortality were separately calculated for gender and age-class, in subjects with and without diabetes. RESULTS: 65,165 hospital discharges with IS diagnosis were identified. Diabetes was associated with increased risk of stroke OR(95%CI):1.31(1.28-1.34) in males; 1.24(1.21-1.37) in females. Diabetic females, compared to males, had a higher in-hospital mortality risk after IS (OR:1.32; 1.06-1.64), while in non diabetic subjects there was no difference between genders. Incidence of IS declined in non-diabetic subjects, except for women aged ≤70 yr; a similar reduction was observed for in-hospital mortality. Among diabetic patients, conversely, annual incidence of IS rose by 3% in the elderly(>70 yr) and annual mortality trend remained unchanged. CONCLUSIONS: In the last decade, the incidence of IS and of related in-hospital mortality declined in persons without diabetes, while increasing among diabetic patients of advanced age. Diabetic females, compared to males, had a higher in-hospital mortality risk. This article is protected by copyright. All rights reserved.