title: The incidence and relative risk of stroke among patients with bipolar disorder: a seven-year follow-up study.
abstract: OBJECTIVE
  This study aimed to estimate the incidence and relative risk of stroke and post-stroke all-cause mortality among patients with bipolar disorder.
  
  
  METHODS
  This study identified a study population from the National Health Insurance Research Database (NHIRD) between 1999 and 2003 that included 16,821 patients with bipolar disorder and 67,284 age- and sex-matched control participants without bipolar disorder. The participants who had experienced a stroke between 1999 and 2003 were excluded and were randomly selected from the NHIRD. The incidence of stroke (ICD-9-CM code 430-438) and patient survival after stroke were calculated for both groups using data from the NIHRD between 2004 and 2010. A Cox proportional-hazards model was used to compare the seven-year stroke-free survival rate and all-cause mortality rate across the two cohorts after adjusting for confounding risk factors.
  
  
  RESULTS
  A total of 472 (2.81%) patients with bipolar disorder and 1,443 (2.14%) controls had strokes over seven years. Patients with bipolar disorder were 1.24 times more likely to have a stroke (95% CI = 1.12-1.38; p<0.0001) after adjusting for demographic characteristics and comorbid medical conditions. In addition, 513 (26.8%) patients who had a stroke died during the follow-up period. The all-cause mortality hazard ratio for patients with bipolar disorder was 1.28 (95% CI = 1.06-1.55; p = 0.012) after adjusting for patient, physician and hospital variables.
  
  
  CONCLUSIONS
  The likelihood of developing a stroke was greater among patients with bipolar disorder than controls, and the all-cause mortality rate was higher among patients with bipolar disorder than controls during a seven-year follow-up period.
authors.affiliation: Department of Addiction Science, Kai-Syuan Psychiatric Hospital, Kaohsiung City, Taiwan.
authors.forename: Hung-Chi
authors.initials: HC
authors.lastname: Wu
authors.forename: Frank Huang-Chih
authors.initials: FH
authors.lastname: Chou
authors.forename: Kuan-Yi
authors.initials: KY
authors.lastname: Tsai
authors.forename: Chao-Yueh
authors.initials: CY
authors.lastname: Su
authors.forename: Shih-Pei
authors.initials: SP
authors.lastname: Shen
authors.forename: Tieh-Chi
authors.initials: TC
authors.lastname: Chung
mesh_terms: D000328:Adult; D001714:Bipolar Disorder / Q000150:complications* / Q000453:epidemiology*; D016022:Case-Control Studies; D015897:Comorbidity; D003710:Demography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D010820:Physicians; D016016:Proportional Hazards Models; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology* / Q000209:etiology*; D013624:Taiwan / Q000453:epidemiology
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