title: Type 2 Diabetes and Hemorrhagic Stroke: A Population-Based Study in Spain from 2003 to 2012.
abstract: OBJECTIVE
  The objective of this study is to compare trends in outcomes for intracerebral hemorrhagic stroke in people with or without type 2 diabetes in Spain between 2003 and 2012.
  
  
  METHODS
  We selected all patients hospitalized for hemorrhagic stroke using national hospital discharge data. We evaluated annual incident rates stratified by diabetes status. We analyzed trends in the use of diagnostic and therapeutic procedures, patient comorbidities, in-hospital mortality (IHM), length of hospital stay, and readmission rate in 1 month.
  
  
  RESULTS
  We identified a total of 173,979 discharges of patients admitted with hemorrhagic stroke (19.1% with diabetes). Incidences were higher among those with than those without diabetes in all the years studied. Diabetes was positively associated with stroke (incidence rate ratio [IRR] = 1.38, 95% confidence interval [CI] 1.35-1.40 for men; IRR = 1.31, 95% CI 1.29-1.34 for women). Length of stay decreased significantly and readmission rate remained stable for both groups (around 5%). We observed a significant increase in the use of decompressive craniectomy from 2002 to 2013. Mortality was positively associated with older age, with higher comorbidity and atrial fibrillation as risk factors. We found a negative association with the use of decompressive craniectomy. Mortality did not change over time among diabetic men and women. In those without diabetes, mortality decreased significantly over time. Suffering diabetes was not associated with higher mortality.
  
  
  CONCLUSIONS
  Type 2 diabetes is associated with higher incidence of hemorrhagic stroke but not with IHM. Incidence among diabetic people remained stable over time. In both groups, the use of decompressive craniectomy has increased and is associated with a decreased mortality.
authors.affiliation: Medicine Department, Hospital Universitario Infanta Leonor, Madrid, Spain.
authors.forename: Nuria
authors.initials: N
authors.lastname: Muñoz-Rivas
authors.affiliation: Medicine Department, Hospital Clínico San Carlos, Madrid, Spain.
authors.forename: Manuel
authors.initials: M
authors.lastname: Méndez-Bailón
authors.affiliation: Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Madrid, Spain.
authors.forename: Valentín
authors.initials: V
authors.lastname: Hernández-Barrera
authors.affiliation: Medicine Department, Hospital Gregorio Marañon, Madrid, Spain.
authors.forename: José M
authors.initials: JM
authors.lastname: de Miguel-Yanes
authors.affiliation: Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Madrid, Spain. Electronic address: rodrigo.jimenez@urjc.es.
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Jimenez-Garcia
authors.affiliation: Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Madrid, Spain.
authors.forename: Jesus
authors.initials: J
authors.lastname: Esteban-Hernández
authors.affiliation: Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Madrid, Spain.
authors.forename: Ana
authors.initials: A
authors.lastname: Lopez-de-Andrés
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000453:epidemiology; D016009:Chi-Square Distribution; D015897:Comorbidity; D003399:Craniotomy; D019299:Decompression, Surgical / Q000379:methods; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D015994:Incidence; D020300:Intracranial Hemorrhages / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality / Q000601:surgery; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010343:Patient Admission; D010359:Patient Readmission; D012189:Retrospective Studies; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology; D020521:Stroke / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality / Q000601:surgery; D013997:Time Factors; D016896:Treatment Outcome
keywords: Type 2 diabetes mellitus; hemorrhagic stroke; hospitalization; in-hospital mortality; incidence; length of stay