Clinical Epidemiology (Apr 2019)
Epilepsy is associated with higher subsequent mortality risk in patients after stroke: a population-based cohort study in Taiwan
Abstract
Tomor Harnod,1,2 Cheng-Li Lin,3,4 Chia-Hung Kao5–71Department of Neurosurgery, Hualien Tzu Chi General Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan; 2College of Medicine, Tzu Chi University, Hualien, Taiwan; 3Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan; 4College of Medicine, China Medical University, Taichung, Taiwan; 5Graduate Institute of Biomedical Sciences, College of Medicine, China Medical University, Taichung, Taiwan; 6Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan; 7Department of Bioinformatics and Medical Engineering, Asia University, Taichung, TaiwanObjective: To use the National Health Insurance Research Database (NHIRD) of Taiwan to determine whether patients with poststroke epilepsy (PSE) in Taiwan have an increased risk of mortality.Methods: We analyzed the data from the NHIRD of patients (≥40 years) who had received stroke diagnoses between 2000 and 2012. The patients with stroke were divided into PSE and poststroke non-epilepsy (PSN) cohorts and compared against a sex-, age-, comorbidity-, and index-date-matched cohort from normal population. We calculated adjusted HRs (aHRs) and 95% CIs of all-cause mortality risk in these cohorts after adjustment for age, sex, and comorbidities.Results: Among the poststroke patients, 12.14% constituted the PSE cohort. The cumulative mortality rate was considerably higher in the PSE than in the PSN cohort. The PSE (aHR=4.18, 95% CI=3.91–4.48) and PSN (aHR=1.90, 95% CI=1.83–1.98) cohorts were associated with higher risks of mortality than the comparison cohort. Furthermore, advanced age (≥65 years), male sex, alcohol-related illness, chronic obstructive pulmonary disease, coronary artery disease, diabetes, hypertension, asthma, and cancer would further increase the risk of mortality after a stroke event.Conclusion: The mortality risk in poststroke patients is approximately two times the likelihood in those with PSE than in those without, and approximately four times higher than that in the normal population. Our findings provide crucial information for clinicians and the government to improve survival after stroke.Keywords: cohort study, epilepsy, mortality, stroke, National Health Insurance
