Time Trends in Ischemic Stroke among Type 2 Diabetic and Non-Diabetic Patients: Analysis of the Spanish National Hospital Discharge Data (2003-2012)

Muñoz‐Rivas, Nuria; Méndez‐Bailón, Manuel; Hernández-Barrera, Valentín; Miguel‐Yanes, José M. de; Jiménez‐García, Rodrigo; Hernández, Juan Martínez; Jiménez‐Trujillo, Isabel; Álvaro-Meca, Alejandro; Carrasco‐Garrido, Pilar; Miguel-Díez, Javier de; López‐de‐Andrés, Ana

doi:10.1371/journal.pone.0145535

Cited by 34 publications

(36 citation statements)

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“…The less frequent use of diagnostic procedures among women than men is remarkable. This finding was previously reported in Spanish studies on PE and other diseases and should be investigated in the future …”

Section: Discussionsupporting

confidence: 85%

Type 2 diabetes is associated with a higher incidence of hospitalization for pulmonary embolism in Spain: Analysis of hospital discharge data during 2004–2013

et al. 2016

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Background and objective: We compared the incidence and outcome of pulmonary embolism (PE) in individuals with and without type 2 diabetes mellitus (T2DM) in Spain during 2004-2013.Methods: The study was based on National Hospital Discharge Data, and the study population comprised patients hospitalized for PE. Annual incidence rates were classified according to T2DM status. In-hospital mortality (IHM), length of hospital stay (LOHS), comorbidities and use of diagnosis and therapeutic procedures were analysed. Results: We identified 123 872 discharges of patients (56 361 men and 67 511 women) with PE as their primary diagnosis (15.3% with T2DM). Incidence of discharge diagnoses of PE increased significantly in all groups. Crude rates were higher in diabetic patients. A positive association was identified between T2DM and PE: adjusted IRR was 2.00 (95% CI: 1.95-2.05) for men and 2.50 (95% CI: 2.45-2.57) for women. LOHS, readmissions and IHM decreased significantly for both groups. An association between IHM and risk factors (older age, Charlson comorbidity index >3, atrial fibrillation and cancer) was observed. T2DM was associated with higher IHM in men (OR: 1.22, 95% CI: 1.12-1.32) and women (OR: 1.24, 95% CI: 1.15-1.33). The use of computed tomography pulmonary angiography increased significantly overtime. Conclusion: We confirmed that in both men and women, diabetes was an independent risk factor for IHM. The incidence of discharge of patients with PE increased significantly during the study period. Diabetic

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Section: Discussionsupporting

confidence: 85%

Type 2 diabetes is associated with a higher incidence of hospitalization for pulmonary embolism in Spain: Analysis of hospital discharge data during 2004–2013

et al. 2016

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“…Diagnosis and procedures are codified according to the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM). Details on this database have been published previously [18, 19]. …”

Section: Methodsmentioning

confidence: 99%

Predictors of in-hospital mortality following major lower extremity amputations in type 2 diabetic patients using artificial neural networks

López‐de‐Andrés

Hernández‐Barrera

López³

et al. 2016

BMC Med Res Methodol

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BackgroundOutcome prediction is important in the clinical decision-making process. Artificial neural networks (ANN) have been used to predict the risk of post-operative events, including survival, and are increasingly being used in complex medical decision making. We aimed to use ANN analysis to estimate predictive factors of in-hospital mortality (IHM) in patients with type 2 diabetes (T2DM) after major lower extremity amputation (LEA) in Spain.MethodsWe design a retrospective, observational study using ANN models. We used the Spanish National Hospital Discharge Database to select all hospital admissions of major LEA procedure in T2DM patients. Main outcome measures: Predictors of IHM using 4 ANN models: i) with all discharge diagnosis included in the database; ii) with all discharge diagnosis included in the database, excluding infectious diseases; iii) comorbidities included in the Charlson Comorbidities Index; iv) comorbidities included in the Elixhauser Comorbidity Index.ResultsFrom 2003 to 2013, 40,857 major LEAs in patients with T2DM were identified with a 10.0% IHM. We found that Elixhauser Comorbidity Index model performed better in terms of sensitivity, specificity and precision than Charlson Comorbidity Index model (0.7634 vs 0.7444; 0.9602 vs 0.9121; 0.9511 vs 0.888, respectively). The area under the ROC curve for Elixhauser comorbidity model was 91.7% (95% CI 90.3–93.0) and for Charlson comorbidity model was 88.9% (95% CI; 87.590.2) p = 0.043. Models including all discharge diagnosis with and without infectious diseases showed worse results. In the Elixhauser Comorbidity Index model the most sensitive parameter was age (variable sensitive ratio [VSR] 1.451) followed by female sex (VSR 1.433), congestive heart failure (VSR 1.341), renal failure (VSR 1.274) and chronic pulmonary disease (VSR 1.266).ConclusionsElixhauser Comorbidity Index is a superior comorbidity risk-adjustment model for major LEA survival prediction in patients with T2DM than Charlson Comorbidity Index model using ANN models. Female sex, congestive heart failure, and renal failure are strong predictors of mortality in these patients.

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“…This may underlie the fact that in the United States the adjusted incidence rates of hospital admissions for acute myocardial infarction or fatal coronary artery disease have decreased in recent years [ 4 ]. We have previously reported increasing incidence rates overtime of acute myocardial infarction [ 5 ], ischemic stroke [ 6 ] and admissions for abdominal aortic aneurysm [ 7 ], but declining rates of major lower extremity amputations due to peripheral artery disease for the overall population [ 8 ]. Moreover, incidence rates of major cardiovascular events are higher in people with type 2 diabetes mellitus (T2DM) than among people without diabetes in our Mediterranean population.…”

Section: Introductionmentioning

confidence: 99%

Impact of type 2 diabetes mellitus on in-hospital-mortality after major cardiovascular events in Spain (2002–2014)

Miguel‐Yanes

Jiménez‐García

Hernández-Barrera

et al. 2017

Cardiovasc Diabetol

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BackgroundDiabetes mellitus has long been associated with cardiovascular events. Nevertheless, the higher burden of traditional cardiovascular risk factors reported in high-income countries is offset by a more widespread use of preventive measures and revascularization or other invasive procedures. The aim of this investigation is to describe trends in number of cases and outcomes, in-hospital mortality (IHM) and length of hospital stay (LHS), of hospital admissions for major cardiovascular events between type 2 diabetes (T2DM) and matched non-diabetes patients.MethodsRetrospective study using National Hospital Discharge Database, analyzed in 4 years 2002, 2006, 2010, 2014, in Spain. We included patients (≥ 40 years old) with a primary diagnosis of myocardial infarction, ischemic and hemorrhagic stroke, aortic aneurysm and dissection and acute lower limb ischemia in people with T2DM. Cases were matched with controls (without T2DM) by ICD-9-CM codes, sex, age, province of residence and year.ResultsWe selected 130,011 matched couples (50,427 with myocardial infarction, 60,236 with stroke, 2599 with aortic aneurysm and dissection and 16,749 with acute lower limb ischemia. Among T2DM patients we found increasing numbers of admissions overtime for stroke (10,794 in 2002 vs 17,559 in 2014), aortic aneurysm and dissection (390 vs 841) and acute lower limb ischemia (3854 vs. 4548). People were progressively older (except for myocardial infarction), had more comorbidities (especially T2DM patients), and were more frequently coded overtime for cardiovascular risk factors (smoking, obesity, hypertension, lipid disorders) and renal diseases. LHS and IHM declined overtime, though IHM only did it significantly in T2DM patients. Multivariable adjustment showed that T2DM patients had a significantly 15% higher mortality rate during admission for myocardial infarction, a 6% higher mortality for stroke, and a 6% higher mortality rate for “all cardiovascular events combined”, than non-diabetic matched controls.ConclusionsThe number of hospital admissions for stroke, aortic aneurysm and dissection and acute lower limb ischemia increased overtime, but remained stable for myocardial infarction. T2DM is associated to higher IHM after major cardiovascular events. Further research is needed to help us understand the reasons for an apparently increased mortality in T2DM patients when admitted to hospital for some major cardiovascular events.

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Time Trends in Ischemic Stroke among Type 2 Diabetic and Non-Diabetic Patients: Analysis of the Spanish National Hospital Discharge Data (2003-2012)

Cited by 34 publications

References 50 publications

Type 2 diabetes is associated with a higher incidence of hospitalization for pulmonary embolism in Spain: Analysis of hospital discharge data during 2004–2013

Type 2 diabetes is associated with a higher incidence of hospitalization for pulmonary embolism in Spain: Analysis of hospital discharge data during 2004–2013

Predictors of in-hospital mortality following major lower extremity amputations in type 2 diabetic patients using artificial neural networks

Impact of type 2 diabetes mellitus on in-hospital-mortality after major cardiovascular events in Spain (2002–2014)

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