Incident ischaemic stroke and Type 2 diabetes: trends in incidence and case fatality in Scotland 2004–2013

• Published in: Diabetic medicine Vol. 35; no. 1; pp. 99 - 106
• Main Authors: Read, S. H., McAllister, D. A., Colhoun, H. M., Farran, B., Fischbacher, C., Kerssens, J. J., Leese, G. P., Lindsay, R. S., McCrimmon, R. J., McGurnaghan, S., Philip, S., Sattar, N., Wild, S. H.
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01.01.2018
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Brain Ischemia - complications; Brain Ischemia - epidemiology; Brain Ischemia - mortality; Cardiovascular diseases; Cardiovascular system; Cohort Studies; Diabetes; Diabetes mellitus; Diabetes Mellitus, Type 2 - epidemiology; Diagnosis; Fatalities; Female; Health risk assessment; Humans; Incidence; Logistic Models; Male; Middle Aged; Mortality; Patient admissions; Regression analysis; Retrospective Studies; Scotland - epidemiology; Stroke; Stroke - epidemiology; Stroke - etiology; Stroke - mortality; Trends; Young Adult; United Kingdom > UK; Scotland
• ISSN: 0742-3071; 1464-5491
• DOI: 10.1111/dme.13528

Aim To describe trends in first ischaemic stroke incidence and case fatality in adults with and without a diagnosis of Type 2 diabetes prior to their ischaemic stroke event in Scotland between 2004 and 2013. Methods Using population‐wide hospital admission, death and diabetes datasets, we conducted a retrospective cohort study. Negative binomial and logistic regression models were used to calculate year‐specific incidence and case‐fatality rates for people with Type 2 diabetes and for people without diabetes. Results During 41.0 million person‐years of follow‐up there were 69 757 ischaemic stroke events. Type 2 diabetes prevalence among patients who experienced ischaemic stroke increased from 13.5% to 20.3% between 2004 and 2013. Stroke incidence rates declined by 2.7% (95% CI 2.4, 3.0) annually for people with and without diabetes [diabetes/year interaction: rate ratio 0.99 (95% CI 0.98, 1.01)]. Type 2 diabetes was associated with an increased risk of ischaemic stroke in men [rate ratio 1.23 (95% CI 1.17, 1.30)] and women [rate ratio 1.41 (95% CI 1.35, 1.48)]. Case‐fatality rates were 14.2% and 12.7% in people with Type 2 diabetes and without diabetes, respectively. Case fatality declined by 3.5% (95% CI 2.7, 4.5) annually [diabetes/year interaction: odds ratio 1.01 (95% CI 0.98, 1.02)]. Conclusions Ischaemic stroke incidence declined no faster in people with a diagnosis of Type 2 diabetes than in people without diabetes. Increasing prevalence of Type 2 diabetes among stroke patients may mean that declines in case fatality over time will be less marked in the future. What's new? Using population‐wide registers we describe contemporary trends in ischaemic stroke incidence and case fatality in people with and without a diagnosis of Type 2 diabetes. Declines in ischaemic stroke incidence and case fatality have occurred at the same rate in people with and without a diagnosis of Type 2 diabetes, despite attempts to intensify cardiovascular disease risk factor control in people with diabetes. Between 2004 and 2013, the prevalence of Type 2 diabetes in patients experiencing ischaemic stroke in Scotland increased from 13.5% to 20.3%.