Epidemiology of ischemic stroke in patients with diabetes: the greater Cincinnati/Northern Kentucky Stroke Study.
OBJECTIVE
Diabetes is a well known risk factor for stroke, but the impact of diabetes on stroke incidence rates is not known. This study uses a population-based study to describe the epidemiology of ischemic stroke in diabetic patients.


METHODS
Hospitalized cases were ascertained by ICD-9 discharge codes, prospective screening of emergency department admission logs, and review of coroner's cases. A sampling scheme was used to ascertain cases in the out-of-hospital setting. All potential cases underwent detailed chart abstraction by study nurses followed by physician review. Diabetes-specific incidence rates, case fatality rates, and population-attributable risks were estimated.


RESULTS
Ischemic stroke patients with diabetes are younger, more likely to be African American, and more likely to have hypertension, myocardial infarction, and high cholesterol than nondiabetic patients. Age-specific incidence rates and rate ratios show that diabetes increases ischemic stroke incidence at all ages, but this risk is most prominent before age 55 in African Americans and before age 65 in whites. One-year case fatality rates after ischemic stroke are not different between those patients with and without diabetes.


CONCLUSIONS
Given the "epidemic" of diabetes, with substantially increasing diabetes prevalence each year across all age- and race/ethnicity groups, the significance of diabetes as a risk factor for stroke is becoming more evident. Diabetes is clearly one of the most important risk factors for ischemic stroke, especially in those patients less than 65 years of age. We estimate that 37-42% of all ischemic strokes in both African Americans and whites are attributable to the effects of diabetes alone or in combination with hypertension.
Kissela
Brett M
BM
Department of Neurology, University of Cincinnati, 231 Albert Sabin Way, ML 0525, Cincinnati, OH 45267-0525, USA. Brett.Kissela@uc.edu
Khoury
Jane
J
Kleindorfer
Dawn
D
Woo
Daniel
D
Schneider
Alexander
A
Alwell
Kathleen
K
Miller
Rosemary
R
Ewing
Irene
I
Moomaw
Charles J
CJ
Szaflarski
Jerzy P
JP
Gebel
James
J
Shukla
Rakesh
R
Broderick
Joseph P
JP
D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D044383:Black People / Q000706:statistics & numerical data; D002545:Brain Ischemia / Q000453:epidemiology*; D003920:Diabetes Mellitus / Q000453:epidemiology*; D005260:Female; D006801:Humans; D015994:Incidence; D007629:Kentucky / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009820:Ohio / Q000453:epidemiology; D015995:Prevalence; D020521:Stroke / Q000453:epidemiology*; D044465:White People / Q000706:statistics & numerical data; D001741:Black or African American