Associated demographic factors for the recurrence and prognosis of stroke patients within a multiethnic Asian population

Abstract

Objective:

There is a paucity of studies investigating the outcomes among Asian stroke patients. Identifying subgroups of stroke patients at risk of poorer outcomes could identify patients who would benefit from targeted interventions. Therefore, the aim of this study was to identify which ischemic stroke patients at high risk of recurrent events and mortality.

Methods:

This cohort study adhered to STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) guidelines. We obtained data from the Singapore Stroke Registry (SSR) from 2005 to 2016 and cross referenced to the Death Registry and the Myocardial Infarction Registry. Outcome measures included recurrent stroke, acute myocardial infarction (AMI), and all-cause and stroke-related deaths. Multivariable Cox proportional hazards regression models were performed to determine risk factors for recurrent stroke, AMI, and all-cause and stroke-related deaths.

Results:

A total of 64,915 patients (6705 young, and 58,210 older) were included in our analysis. Older stroke patients were found to have an increased risk of recurrent stroke (hazard ratio (HR) = 1.21, 95% confidence interval (CI) = 1.12–1.30), AMI (HR = 1.73, 95% CI = 1.54–1.95), all-cause death (HR = 2.49, 95% CI = 2.34–2.64), and stroke-related death (HR = 176, 95% CI = 1.61–1.92). Among young stroke patients, males were at increased risk for recurrent stroke (HR = 1.18, 95% CI = 1.01–1.39) and AMI (HR = 1.41, 95% CI = 1.08–1.83), but at reduced risk for all-cause (HR = 0.78, 95% CI = 0.69–0.89) and stroke-related deaths (HR = 0.79, 95% CI = 0.67–0.94). Ethnicity appeared to influence outcomes, with Malay patients at increased risk of recurrent stroke (HR = 1.37, 95% CI = 1.14–1.65), AMI (HR = 2.45, 95% CI = 1.87–3.22), and all-cause (HR = 1.43, 95% CI = 1.24–1.66) and stroke-related deaths (HR = 1.34, 95% CI = 1.09–1.64). Indian patients were also at increased risk of AMI (HR = 1.96, 95% CI = 1.41–2.72). Similar findings were seen among the older stroke patients.

Conclusion:

This study found that older stroke patients are at risk of poorer outcomes. Within the young stroke population specifically, males were predisposed to recurrent stroke and AMI but were protected against all-cause and stroke-related deaths. Males were also at reduced risk of all-cause and stroke-related deaths in the older stroke population. In addition, Malay and Indian patients experience poorer outcomes after first stroke. Further optimization of risk factors targeting these high-priority populations are needed to achieve high-quality care.