title: Preadmission use of selective serotonin reuptake inhibitors and short-term mortality in diabetic patients hospitalized due to stroke.
abstract: Patients with diabetes have an increased risk of stroke with a poor prognosis. Moreover, diabetic patients are at increased risk of depression and therefore likely to use selective serotonin reuptake inhibitors (SSRIs). We examined whether preadmission SSRI use was associated with increased mortality in diabetic patients hospitalized due to stroke.
  
  
  
  Population-based medical databases were used to identify all first-time stroke-related hospitalizations and subsequent mortality in diabetic patients in Denmark between 2004 and 2012 (n = 12 620). Based on redeemed prescriptions, SSRI use was categorized as current (new or long term), former or nonuse, and absolute 30-day mortality and mortality rate ratios (MRRs) were computed using Cox regression controlling for confounding factors.
  
  
  
  Amongst SSRI nonusers, 30-day stroke mortality was 15.8% (10.4% for ischaemic stroke, 41.8% for intracerebral haemorrhage and 27.3% for subarachnoid haemorrhage). Amongst current SSRI users, 30-day stroke mortality was 23.3% (17.1% for ischaemic stroke, 50.7% for intracerebral haemorrhage and 28.6% for subarachnoid haemorrhage). Current SSRI use was associated with increased 30-day stroke mortality compared with nonuse [adjusted MRR 1.3, 95% confidence interval (CI) 1.1-1.5], with the highest risk observed amongst new users (MRR 1.5, 95% CI 1.2-1.8). Overall stroke mortality was driven by increased mortality due to ischaemic stroke, with adjusted MRRs of 1.3 (95% CI 1.1-1.7) for current users and 1.7 (95% CI 1.2-2.4) for new users. Propensity score-matched results were similar and robust across subgroups.
  
  
  
  In patients with diabetes, preadmission SSRI use was associated with increased mortality following ischaemic stroke, compared with nonuse.
authors.affiliation: Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark. morten.wurtz@clin.au.dk.|Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark. morten.wurtz@clin.au.dk.|Department of Internal Medicine, Regional Hospital West Jutland, Herning, Denmark. morten.wurtz@clin.au.dk.
authors.forename: M
authors.initials: M
authors.lastname: Würtz
authors.affiliation: Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: M
authors.initials: M
authors.lastname: Schmidt
authors.affiliation: Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.|Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: E L
authors.identifier: 0000-0002-1466-0865
authors.initials: EL
authors.lastname: Grove
authors.affiliation: Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: E
authors.initials: E
authors.lastname: Horváth-Puhó
authors.affiliation: Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: C F
authors.initials: CF
authors.lastname: Christiansen
authors.affiliation: Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: H T
authors.initials: HT
authors.lastname: Sørensen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003863:Depression / Q000188:drug therapy*; D003920:Diabetes Mellitus / Q000523:psychology*; D003925:Diabetic Angiopathies / Q000401:mortality*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D017367:Selective Serotonin Reuptake Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D020521:Stroke / Q000401:mortality*
chemical_list: D017367:Selective Serotonin Reuptake Inhibitors
keywords: depression; diabetes; mortality; selective serotonin reuptake inhibitors; stroke