Sex-related disparities in the incidence and outcomes of hemorrhagic stroke among type 2 diabetes patients: a propensity score matching analysis using the Spanish National Hospital Discharge Database for the period 2016–18
Abstract Background To analyze incidence, use of therapeutic procedures, use of oral anticoagulants (OACs) and antiplatelet agents prior to hospitalization, and in-hospital outcomes among patients who were hospitalized with hemorrhagic stroke (HS) according to the presence of type 2 diabetes mellitu...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2021-07-01
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| Series: | Cardiovascular Diabetology |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12933-021-01334-2 |
| _version_ | 1818859645385572352 |
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| author | Ana Lopez-de-Andres Rodrigo Jimenez-Garcia Valentín Hernández-Barrera Isabel Jiménez-Trujillo José M. de Miguel-Yanes David Carabantes-Alarcon Javier de Miguel-Diez Marta Lopez-Herranz |
| author_facet | Ana Lopez-de-Andres Rodrigo Jimenez-Garcia Valentín Hernández-Barrera Isabel Jiménez-Trujillo José M. de Miguel-Yanes David Carabantes-Alarcon Javier de Miguel-Diez Marta Lopez-Herranz |
| author_sort | Ana Lopez-de-Andres |
| collection | DOAJ |
| description | Abstract Background To analyze incidence, use of therapeutic procedures, use of oral anticoagulants (OACs) and antiplatelet agents prior to hospitalization, and in-hospital outcomes among patients who were hospitalized with hemorrhagic stroke (HS) according to the presence of type 2 diabetes mellitus (T2DM) in Spain (2016–2018) and to assess the role of sex differences among those with T2DM. Methods Using the Spanish National Hospital Discharge Database we estimated the incidence of HS hospitalizations in men and women aged ≥ 35 years with and without T2DM. Propensity score matching (PSM) was used to compare population subgroups according to sex and the presence of T2DM. Results HS was coded in 31,425 men and 24,975 women, of whom 11,915 (21.12%) had T2DM. The adjusted incidence of HS was significantly higher in patients with T2DM (both sexes) than in non-T2DM individuals (IRR 1.15; 95% CI 1.12–1.17). The incidence of HS was higher in men with T2DM than in T2DM women (adjusted IRR 1.60; 95% CI 1.57–1.63). After PSM, men and women with T2DM have significantly less frequently received decompressive craniectomy than those without T2DM. In-hospital mortality (IHM) was higher among T2DM women than matched non-T2DM women (32.89% vs 30.83%; p = 0.037), with no differences among men. Decompressive craniectomy was significantly more common in men than in matched women with T2DM (5.81% vs. 3.33%; p < 0.001). IHM was higher among T2DM women than T2DM men (32.89% vs. 28.28%; p < 0.001). After adjusting for confounders with multivariable logistic regression, women with T2DM had a 18% higher mortality risk than T2DM men (OR 1.18; 95% CI 1.07–1.29). Use of OACs and antiplatelet agents prior to hospitalization were associated to higher IHM in men and women with and without T2DM. Conclusions T2DM is associated with a higher incidence of HS and with less frequent use of decompressive craniectomy in both sexes, but with higher IHM only among women. Sex differences were detected in T2DM patients who had experienced HS, with higher incidence rates, more frequent decompressive craniectomy, and lower IHM in men than in women. |
| first_indexed | 2024-12-19T09:15:28Z |
| format | Article |
| id | doaj.art-e6e02c010c5a4783959bb4742ec2c895 |
| institution | Directory Open Access Journal |
| issn | 1475-2840 |
| language | English |
| last_indexed | 2024-12-19T09:15:28Z |
| publishDate | 2021-07-01 |
| publisher | BMC |
| record_format | Article |
| series | Cardiovascular Diabetology |
| spelling | doaj.art-e6e02c010c5a4783959bb4742ec2c8952022-12-21T20:28:07ZengBMCCardiovascular Diabetology1475-28402021-07-0120111410.1186/s12933-021-01334-2Sex-related disparities in the incidence and outcomes of hemorrhagic stroke among type 2 diabetes patients: a propensity score matching analysis using the Spanish National Hospital Discharge Database for the period 2016–18Ana Lopez-de-Andres0Rodrigo Jimenez-Garcia1Valentín Hernández-Barrera2Isabel Jiménez-Trujillo3José M. de Miguel-Yanes4David Carabantes-Alarcon5Javier de Miguel-Diez6Marta Lopez-Herranz7Department of Public Health & Maternal and Child Health, Faculty of Medicine, Universidad Complutense de MadridDepartment of Public Health & Maternal and Child Health, Faculty of Medicine, Universidad Complutense de MadridPreventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos UniversityPreventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos UniversityInternal Medicine Department. Hospital General, Universitario Gregorio Marañón, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM)Department of Public Health & Maternal and Child Health, Faculty of Medicine, Universidad Complutense de MadridRespiratory Care Department, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM)Faculty of Nursing, Physiotherapy and Podology, Universidad Complutense de MadridAbstract Background To analyze incidence, use of therapeutic procedures, use of oral anticoagulants (OACs) and antiplatelet agents prior to hospitalization, and in-hospital outcomes among patients who were hospitalized with hemorrhagic stroke (HS) according to the presence of type 2 diabetes mellitus (T2DM) in Spain (2016–2018) and to assess the role of sex differences among those with T2DM. Methods Using the Spanish National Hospital Discharge Database we estimated the incidence of HS hospitalizations in men and women aged ≥ 35 years with and without T2DM. Propensity score matching (PSM) was used to compare population subgroups according to sex and the presence of T2DM. Results HS was coded in 31,425 men and 24,975 women, of whom 11,915 (21.12%) had T2DM. The adjusted incidence of HS was significantly higher in patients with T2DM (both sexes) than in non-T2DM individuals (IRR 1.15; 95% CI 1.12–1.17). The incidence of HS was higher in men with T2DM than in T2DM women (adjusted IRR 1.60; 95% CI 1.57–1.63). After PSM, men and women with T2DM have significantly less frequently received decompressive craniectomy than those without T2DM. In-hospital mortality (IHM) was higher among T2DM women than matched non-T2DM women (32.89% vs 30.83%; p = 0.037), with no differences among men. Decompressive craniectomy was significantly more common in men than in matched women with T2DM (5.81% vs. 3.33%; p < 0.001). IHM was higher among T2DM women than T2DM men (32.89% vs. 28.28%; p < 0.001). After adjusting for confounders with multivariable logistic regression, women with T2DM had a 18% higher mortality risk than T2DM men (OR 1.18; 95% CI 1.07–1.29). Use of OACs and antiplatelet agents prior to hospitalization were associated to higher IHM in men and women with and without T2DM. Conclusions T2DM is associated with a higher incidence of HS and with less frequent use of decompressive craniectomy in both sexes, but with higher IHM only among women. Sex differences were detected in T2DM patients who had experienced HS, with higher incidence rates, more frequent decompressive craniectomy, and lower IHM in men than in women.https://doi.org/10.1186/s12933-021-01334-2Hemorrhagic strokeType 2 diabetes mellitusSex differencesIncidenceIn-hospital mortalityOral anticoagulants |
| spellingShingle | Ana Lopez-de-Andres Rodrigo Jimenez-Garcia Valentín Hernández-Barrera Isabel Jiménez-Trujillo José M. de Miguel-Yanes David Carabantes-Alarcon Javier de Miguel-Diez Marta Lopez-Herranz Sex-related disparities in the incidence and outcomes of hemorrhagic stroke among type 2 diabetes patients: a propensity score matching analysis using the Spanish National Hospital Discharge Database for the period 2016–18 Cardiovascular Diabetology Hemorrhagic stroke Type 2 diabetes mellitus Sex differences Incidence In-hospital mortality Oral anticoagulants |
| title | Sex-related disparities in the incidence and outcomes of hemorrhagic stroke among type 2 diabetes patients: a propensity score matching analysis using the Spanish National Hospital Discharge Database for the period 2016–18 |
| title_full | Sex-related disparities in the incidence and outcomes of hemorrhagic stroke among type 2 diabetes patients: a propensity score matching analysis using the Spanish National Hospital Discharge Database for the period 2016–18 |
| title_fullStr | Sex-related disparities in the incidence and outcomes of hemorrhagic stroke among type 2 diabetes patients: a propensity score matching analysis using the Spanish National Hospital Discharge Database for the period 2016–18 |
| title_full_unstemmed | Sex-related disparities in the incidence and outcomes of hemorrhagic stroke among type 2 diabetes patients: a propensity score matching analysis using the Spanish National Hospital Discharge Database for the period 2016–18 |
| title_short | Sex-related disparities in the incidence and outcomes of hemorrhagic stroke among type 2 diabetes patients: a propensity score matching analysis using the Spanish National Hospital Discharge Database for the period 2016–18 |
| title_sort | sex related disparities in the incidence and outcomes of hemorrhagic stroke among type 2 diabetes patients a propensity score matching analysis using the spanish national hospital discharge database for the period 2016 18 |
| topic | Hemorrhagic stroke Type 2 diabetes mellitus Sex differences Incidence In-hospital mortality Oral anticoagulants |
| url | https://doi.org/10.1186/s12933-021-01334-2 |
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