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. 2021 Jun 10;11(6):e044766.
doi: 10.1136/bmjopen-2020-044766.

Stroke care and case fatality in people with and without schizophrenia: a retrospective cohort study

Moira K Kapral  1   2   3 , Paul Kurdyak  2   3   4 , Leanne K Casaubon  5 , Jiming Fang  2 , Joan Porter  2 , Kathleen A Sheehan  4
Affiliations

Stroke care and case fatality in people with and without schizophrenia: a retrospective cohort study

Moira K Kapral et al. BMJ Open. .

Abstract

Background: Schizophrenia is associated with an increased risk of death following stroke; however, the magnitude and underlying reasons for this are not well understood.

Objective: To determine the association between schizophrenia and stroke case fatality, adjusting for baseline characteristics, stroke severity and processes of care.

Design: Retrospective cohort study used linked clinical and administrative databases.

Setting: All acute care institutions (N=152) in the province of Ontario, Canada.

Participants: All patients (N=52 473) hospitalised with stroke between 1 April 2002 and 31 March 2013 and included in the Ontario Stroke Registry. Those with schizophrenia (n=612) were identified using validated algorithms.

Main outcomes and measures: We compared acute stroke care in those with and without schizophrenia and used Cox proportional hazards models to examine the association between schizophrenia and mortality, adjusting for demographics, comorbidity, stroke severity and processes of care.

Results: Compared with those without schizophrenia, people with schizophrenia were less likely to undergo thrombolysis (10.1% vs 13.4%), carotid imaging (66.3% vs 74.0%), rehabilitation (36.6% vs 46.6% among those with disability at discharge) or be treated with antihypertensive, lipid-lowering or anticoagulant therapies. After adjustment for age and other factors, schizophrenia was associated with death from any cause at 1 year (adjusted HR (aHR) 1.33, 95% CI 1.14 to 1.54). This was mainly attributable to early deaths from stroke (aHR 1.47, 95% CI 1.20 to 1.80, with survival curves separating in the first 30 days), and the survival disadvantage was particularly marked in those aged over 70 years (1-year mortality 46.9% vs 35.0%).

Conclusions: Schizophrenia is associated with increased stroke case fatality, which is not fully explained by stroke severity, measurable comorbid conditions or processes of care. Future work should focus on understanding this mortality gap and on improving acute stroke and secondary preventive care in people with schizophrenia.

Keywords: mental health; quality in healthcare; schizophrenia & psychotic disorders; stroke.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
(A) Cumulative incidence of death due to stroke in people with and without schizophrenia. (B) Cumulative incidence of non-stroke death in people with and without schizophrenia.
Figure 2
Figure 2
Survival after stroke in people with and without schizophrenia, by age group.
See this image and copyright information in PMC

References

    1. Feigin VL, Krishnamurthi RV, Parmar P, et al. . Update on the global burden of ischemic and hemorrhagic stroke in 1990-2013: the GBD 2013 study. Neuroepidemiology 2015;45:161–76. 10.1159/000441085 - DOI - PMC - PubMed
    1. Correll CU, Solmi M, Veronese N, et al. . Prevalence, incidence and mortality from cardiovascular disease in patients with pooled and specific severe mental illness: a large-scale meta-analysis of 3,211,768 patients and 113,383,368 controls. World Psychiatry 2017;16:163–80. 10.1002/wps.20420 - DOI - PMC - PubMed
    1. Tsai K-Y, Lee C-C, Chou Y-M, et al. . The incidence and relative risk of stroke in patients with schizophrenia: a five-year follow-up study. Schizophr Res 2012;138:41–7. 10.1016/j.schres.2012.02.013 - DOI - PubMed
    1. Ringen PA, Engh JA, Birkenaes AB, et al. . Increased mortality in schizophrenia due to cardiovascular disease - a non-systematic review of epidemiology, possible causes, and interventions. Front Psychiatry 2014;5:137. 10.3389/fpsyt.2014.00137 - DOI - PMC - PubMed
    1. Bresee LC, Majumdar SR, Patten SB, et al. . Prevalence of cardiovascular risk factors and disease in people with schizophrenia: a population-based study. Schizophr Res 2010;117:75–82. 10.1016/j.schres.2009.12.016 - DOI - PubMed

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