Stroke in the diabetic and non-diabetic population in Germany: relative and attributable risks, 2005–2007

Icks, Andrea; Scheer, Marsel; Genz, Jutta; Giani, Guido; Glaeske, Gerd; Hoffmann, Falk

doi:10.1016/j.jdiacomp.2010.05.002

Cited by 14 publications

(36 citation statements)

References 31 publications

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“…Fifth, a translation of our results to other populations should be performed with caution since it is known that differences in morbidity as well as demographic and socioeconomic variables exist between health insurance funds (37,38). However, the incidence of stroke in our population was well in line with the incidence of stroke in a well-designed regional register-based study (2,39,40). Furthermore, the population has been used for several analyses regarding comorbidities in diabetes (2,13,14).…”

Section: Discussionsupporting

confidence: 86%

“…However, the incidence of stroke in our population was well in line with the incidence of stroke in a well-designed regional register-based study (2,39,40). Furthermore, the population has been used for several analyses regarding comorbidities in diabetes (2,13,14). …”

Section: Discussionsupporting

confidence: 86%

“…We used data of a cohort of patients with incident stroke, for which analyses on incidence and attributable risks have been published elsewhere (2). In brief, these patients were derived from a statutory health insurance company, the Gmünder ErsatzKasse (GEK), which insures ∼1.6 million people located in all regions of Germany (1.9% of the German population).…”

Section: Methodsmentioning

confidence: 99%

“…Although the reduction of stroke in diabetes has frequently been cited as a primary objective by health systems and organizations (1), diabetic individuals still have an approximately twofold stroke risk compared with nondiabetic patients (2–6). Avoidance of stroke should be targeted for both the associated economic consequences (high costs due to repeated hospitalizations, rehabilitation, home care, and social service support) and quality-of-life issues.…”

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confidence: 99%

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Time-Dependent Impact of Diabetes on Mortality in Patients With Stroke

et al. 2012

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OBJECTIVETo estimate the impact of diabetes on mortality in patients after first stroke event.RESEARCH DESIGN AND METHODSUsing claims data from a nationwide statutory health insurance fund (Gmünder ErsatzKasse), we assessed all deaths in a cohort of 5,757 patients with a first stroke between 2005 and 2007 (69.3% male, mean age 68.1 years, 32.2% with diabetes) up to 2009. By use of Cox regression, we estimated time-dependent hazard ratios (HRs) to compare patients with and without diabetes stratified by sex.RESULTSThe cumulative 5-year mortality was 40.0 and 54.2% in diabetic men and women, and 32.3 and 38.1% in their nondiabetic counterparts, respectively. In males, mortality was significantly lower in diabetic compared with nondiabetic patients in the first 30 days (multiple-adjusted HR 0.67 [95% CI 0.53–0.84]). After approximately a quarter of a year, the diabetes risk increased, yielding crossed survival curves. Later on, mortality risk tended to be similar in diabetic and nondiabetic men (1–2 years: 1.42 [1.09–1.85]; 3–5 years: 1.00 [0.67–1.41]; time dependency of diabetes, P = 0.008). In women, the pattern was similar; however, time dependency was not statistically significant (P = 0.89). Increasing age, hemorrhagic stroke, renal failure (only in men), levels of care dependency, and number of prescribed medications were significantly associated with mortality.CONCLUSIONSWe found a time-dependent mortality risk of diabetes after first stroke in men. Possible explanations may be type of stroke or earlier and more intensive treatment of risk factors in diabetic patients.

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Section: Discussionsupporting

confidence: 86%

Section: Discussionsupporting

confidence: 86%

Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

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Time-Dependent Impact of Diabetes on Mortality in Patients With Stroke

et al. 2012

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“…One of the main research topics was diabetes. Studies concerning prevalence and costs of diabetes as well as epidemiology and mortality of its complications were published ( Geyer et al, 2004 ;Hauner et al, 2007 ;Icks et al, 2009 andIcks et al, 2011 ;K ö ster et al, 2006 andK ö ster et al, 2011 ;Stock et al, 2006 ;von Ferber et al, 2006 andvon Ferber et al, 2007 ). Although such claims data contain many health-related information, they are collected primarily for administrative purposes and a record is generated only if there is an actual encounter with the health-care system ( Schneeweiss and Avorn, 2005 ;Schneeweiss, 2007 ).…”

Section: Introduction ▼mentioning

confidence: 99%

Do Persons that Changed Health Insurance Differ From those Who did not? The Case of Diabetes

Hoffmann

Icks²

2011

Exp Clin Endocrinol Diabetes

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Younger age of stroke in low‐middle income countries is related to healthcare access and quality

Rahbar

Medrano

Diaz-Garelli³

et al. 2022

Ann Clin Transl Neurol

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Stroke is the second leading cause of mortality globally with higher burden and younger age in low‐middle income countries (LMICs) than high‐income countries (HICs). However, it is unclear to what extent differences in healthcare access and quality (HAQ) and prevalence of risk factors between LMICs and HICs contribute to younger age of stroke in LMICs. In this systematic review, we conducted meta‐analysis of 67 articles and compared the mean age of stroke between LMICs and HICs, before and after adjusting for HAQ index. We also compared the prevalence of main stroke risk factors between HICs and LMICs. The unadjusted mean age of stroke in LMICs was significantly lower than HICs (63.1 vs. 68.6), regardless of gender (63.9 vs. 66.6 among men, and 65.6 vs. 70.7 among women) and whether data were collected in population‐ (64.7 vs. 69.5) or hospital‐based (62.6 vs. 65.9) studies (all p < 0.01). However, after adjusting for HAQ index, the difference in the mean age of stroke between LMICs and HICs was not significant (p ≥ 0.10), except among women (p = 0.048). In addition, while the median prevalence of hypertension in LMICs was 23.4% higher than HICs, the prevalence of all other risk factors was lower in LMICs than HICs. Our findings suggest a much larger contribution of HAQ to the younger mean age of stroke in LMICs, as compared with other potential factors. Additional studies on stroke care quality and accessibility are needed in LMICs.

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Stroke in the diabetic and non-diabetic population in Germany: relative and attributable risks, 2005–2007

Cited by 14 publications

References 31 publications

Time-Dependent Impact of Diabetes on Mortality in Patients With Stroke

Time-Dependent Impact of Diabetes on Mortality in Patients With Stroke

Do Persons that Changed Health Insurance Differ From those Who did not? The Case of Diabetes

Younger age of stroke in low‐middle income countries is related to healthcare access and quality

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