Aim
The objective of this study is to compare trends in outcomes for intracerebral hemorrhagic
stroke in people with or without type 2 diabetes in Spain between 2003 and 2012.
Methods
We selected all patients hospitalized for hemorrhagic stroke using national hospital
discharge data. We evaluated annual incident rates stratified by diabetes status.
We analyzed trends in the use of diagnostic and therapeutic procedures, patient comorbidities,
in-hospital mortality (IHM), length of hospital stay, and readmission rate in 1 month.
Results
We identified a total of 173,979 discharges of patients admitted with hemorrhagic
stroke (19.1% with diabetes). Incidences were higher among those with than those without
diabetes in all the years studied. Diabetes was positively associated with stroke
(incidence rate ratio [IRR] = 1.38, 95% confidence interval [CI] 1.35-1.40 for men;
IRR = 1.31, 95% CI 1.29-1.34 for women). Length of stay decreased significantly and
readmission rate remained stable for both groups (around 5%). We observed a significant
increase in the use of decompressive craniectomy from 2002 to 2013. Mortality was
positively associated with older age, with higher comorbidity and atrial fibrillation
as risk factors. We found a negative association with the use of decompressive craniectomy.
Mortality did not change over time among diabetic men and women. In those without
diabetes, mortality decreased significantly over time. Suffering diabetes was not
associated with higher mortality.
Conclusions
Type 2 diabetes is associated with higher incidence of hemorrhagic stroke but not
with IHM. Incidence among diabetic people remained stable over time. In both groups,
the use of decompressive craniectomy has increased and is associated with a decreased
mortality.
Key Words
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References
- Epidemiology of stroke in Europe: geographic and environmental differences.J Neurol Sci. 2007; 262: 85-88
- Stroke.Lancet. 2003; 362: 1211-1224
- Epidemiology of ischemic and hemorrhagic stroke: incidence, prevalence, mortality, and risk factors.Neurol Clin. 2008; : 871-895
- Defunciones según la causa de muerte.(Available at:)http://www.ine.es(Accessed March 11, 2015)Date: 2011
- [The estimated incidence and case fatality rate of ischemic and hemorrhagic cerebrovascular disease in 2002 in Catalonia].Rev Esp Cardiol. 2007; 60: 573-580
- [Epidemiology of cerebrovascular disease in Spain].Clin Invest Arterioscl. 2013; 25: 211-217
- [Incidence of strokes in Spain. Methodological foundations of the IBERICTUS study].Rev Neurol. 2008; 47: 617-623
- Stroke in Spain: epidemiologic incidence and patterns: a health sentinel network study.J Stroke Cerebrovasc Dis. 2009; 18: 11-16
- Stroke and transient ischemic attack incidence rate in Spain: the IBERICTUS Study.Cerebrovasc Dis. 2012; 34: 272-281
- Worldwide stroke incidence and early case fatality reported in 56 population-based studies: a systematic review.Lancet Neurol. 2009; 8: 355-369
- Diabetes mellitus and stroke.Int J Clin Pract. 2006; 60: 48-56
- Duration of diabetes and risk of ischemic stroke: the Northern Manhattan Study.Stroke. 2012; 43: 1212-1217
- The disparity in long-term survival after a first stroke in patients with and without diabetes persists: the Northern Sweden MONICA study.Cerebrovasc Dis. 2012; 34: 153-160
- Diabetes mellitus, fasting blood glucose concentration, and risk of vascular disease: a collaborative meta-analysis of 102 prospective studies.Lancet. 2010; 375: 2215-2222
- Type 2 diabetes and incidence of cardiovascular diseases: a cohort study in 1 ⋅ 9 million people.Lancet Diabetes Endocrinol. 2015; 3: 105-113
- Standards of medical care in diabetes-2013.Diabetes Care. 2013; 36: S11-S66
- Mortality in type 2 diabetes mellitus. Magnitude of the evidence from a systematic review and meta-analysis.Br J Diabetes Vasc Dis. 2013; 13: 192-207
- Conjunto Mínimo Básico de Datos, Hospitales del INSALUD.(Available at:) (Accessed March 11, 2015)
- Encuesta Nacional de Salud de España.(Available at:) (Accessed March 11, 2015)
- Prevalence of diabetes mellitus and impaired glucose regulation in Spain: the [email protected] Study.Diabetologia. 2012; 55: 88-93
- Population estimates.(Available at:)http://www.ine.es(Accessed March 11, 2015)Date: 2010
- A new method of classifying prognostic comorbidity in longitudinal studies: development and validation.J Chronic Dis. 1987; 40: 373-383
- The Danish Centre for Strategic Research in Type 2 Diabetes (DD2) study: collection of baseline data from the first 580 patients.Clin Epidemiol. 2012; 4: 43-48
- Current status of stroke epidemiology in Greece: a panorama.Neurol Neurochir Pol. 2014; 48: 449-457
- Charlson comorbidity index in ischemic stroke and intracerebral hemorrhage as predictor of mortality and functional outcome after 6 months.J Stroke Cerebrovasc Dis. 2013; 22: 214-218
- Physical activity, cardiovascular risk factors, and mortality among Finnish adults with diabetes.Diabetes Care. 2005; 28: 799-805
- Blood pressure targets in subjects with type 2 diabetes mellitus/impaired fasting glucose: observations from traditional and Bayesian random effects meta-analyses of randomized trials.Circulation. 2011; 123: 2799-27810
- Epidemiology of stroke in the young.Stroke. 2003; 34: e13
- Independent contribution of diabetes to increased prevalence and incidence of atrial fibrillation.Diabetes Care. 2009; 32: 1851-1856
- Meta-analysis of cohort and case-control studies of type 2 diabetes mellitus and risk of atrial fibrillation.Am J Cardiol. 2011; 108: 56-62
- Cryptogenic stroke and diabetes: a probable link between silent atrial fibrillation episodes and cerebrovascular disease.Expert Rev Cardiovasc Ther. 2014; 12: 323-329
- Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factor-based approach: the Euro Heart Survey on Atrial Fibrillation.Chest. 2010; 137: 263-272
- Use of the CHA2DS2-VASc and HAS-BLED scores to aid decision making for thromboprophylaxis in nonvalvular atrial fibrillation.Circulation. 2012; 126: 860-865
- Epidemiology of stroke in patients with diabetes.Av Diabetol. 2010; 26: 397-402
- The impact of history of hypertension and type 2 diabetes at baseline on the incidence of stroke and stroke mortality.Stroke. 2005; 36: 2538-2543
- Cerebral neovascularization in diabetes: implications for stroke recovery and beyond.J Cereb Blood Flow Metab. 2014; 34: 553-563
- Diabetes as a risk factor for stroke in women compared with men: a systematic review and meta-analysis of 64 cohorts, including 775, 385 individuals and 12,539 strokes.Lancet. 2014; 383: 1973-1980
- Association between diabetes and stroke subtype on survival and functional outcome 3 month after stroke: data from the European BIOMED Stroke Project.Stroke. 2003; 34: 688-694
- Diabetes is an independent risk factor for in-hospital mortality from acute spontaneous intracerebral hemorrhage.Diabetes Care. 2000; 23: 1527-1532
- National trends in utilization and outcomes of coronary revascularization procedures among people with and without type 2 diabetes in Spain (2001-2011).Cardiovasc Diabetol. 2014; 13: 3
- Risk of stroke with thiazolidinediones: a ten-year nationwide population-based cohort study.Cerebrovasc Dis. 2013; 36: 145-151
- Prevalence of prediabetes and newly diagnosed diabetes in patients with a transient ischemic attack or stroke.Cerebrovasc Dis. 2013; 36: 283-289
Article info
Publication history
Published online: March 23, 2016
Accepted:
February 24,
2016
Received in revised form:
January 16,
2016
Received:
November 25,
2015
Footnotes
Grant support: This study forms part of a research funded by the Fondo de Investigaciones Sanitarias (FIS—Health Research Fund, grant no. PI13/00118, Instituto de Salud Carlos III).
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2016.02.031
Copyright
© 2016 National Stroke Association. Published by Elsevier Inc. All rights reserved.
