Poststroke Parkinsonism associates with an increased mortality risk in patients

Dorji Harnod; Tomor Harnod; Cheng-Li Lin; Chung Y Hsu; Chia-Hung Kao

doi:10.21037/atm.2020.03.90

Poststroke Parkinsonism associates with an increased mortality risk in patients

Ann Transl Med. 2020 Apr;8(7):471. doi: 10.21037/atm.2020.03.90.

Authors

Dorji Harnod^{1

2}, Tomor Harnod^{3

4}, Cheng-Li Lin^{5

6}, Chung Y Hsu⁷, Chia-Hung Kao^{7

8

9

10}

Affiliations

¹ Department of Emergency and Critical Care Medicine, Fu Jen Catholic University Hospital, Fu Jen Catholic University, New Taipei City.
² School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei City.
³ Department of Neurosurgery, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien.
⁴ College of Medicine, Tzu Chi University, Hualien.
⁵ Management Office for Health Data, China Medical University Hospital, Taichung.
⁶ College of Medicine, China Medical University, Taichung.
⁷ Graduate Institute of Biomedical Sciences, China Medical University, Taichung.
⁸ Center of Augmented Intelligence in Healthcare, China Medical University Hospital, Taichung.
⁹ Department of Nuclear Medicine and PET Center, and Center of Augmented Intelligence in Healthcare, China Medical University Hospital, Taichung.
¹⁰ Department of Bioinformatics and Medical Engineering, Asia University, Taichung.

Abstract

Background: To determine whether poststroke Parkinsonism (PSP) increases mortality risk in poststroke patients by using Taiwan National Health Insurance Research Database (NHIRD).

Methods: We analyzed NHIRD data of ≥40-year-old patients diagnosed as having stroke [International Classification of Disease, Ninth Revision, Clinical Modification (ICD-9-CM) codes 430-438] between 2000 and 2013. Poststroke patients were divided into those with subsequent PSP (ICD-9-CM codes 332, 332.0, and 332.1) and without PSP (non-Parkinsonism, PSN) cohorts, all compared with a sex-, age-, comorbidity-, and index date-matched comparison cohort. We calculated adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) of all-cause mortality risk in these cohorts after adjustments for age, sex, and comorbidities.

Results: PSP was noted in 11.87% (1,644/13,846) of poststroke patients. In the PSN, PSP, and comparison cohorts, mortality incidence rates were 69.1, 124.9, and 38.8 per 1,000 person-years, respectively. Compared with the comparison cohort, the mortality risks in patients aged 40 to 64, 65 to 74, and ≥75 years were respectively 2.21-, 1.91-, and 1.86-fold higher mortality risks in the PSN cohort and 4.57-, 2.84-, and 2.27-fold higher mortality risks in the PSP cohort. Male sex further increased mortality risk in poststroke patients with PSP.

Conclusions: Long-term all-cause mortality risk is increased by 1.39 times in poststroke patients with PSP than in those without. Our findings depict vital information in incidence and risk of PSP. Those would aid clinicians and the government to improve future poststroke care.

Keywords: Cohort study; National Health Insurance; Parkinsonism; mortality; stroke.