Long-term causes of death in 888,003 ischemic stroke patients in Thailand: a nationwide retrospective study with 18-year follow-up.
This study found that 47.6% of ischemic stroke patients died over 18 years, with complications and comorbidities being the leading long-term causes of death.
Where it sits
this study against the rest of the afamelanotide corpusSummary and findings
This study investigated long-term mortality and causes of death in 888,003 ischemic stroke patients in Thailand over an 18-year follow-up. The overall mortality rate was 47.6%, with specific rates of 6.4% in-hospital, 8.2% within 30 days post-discharge, and 33.1% beyond 30 days. The leading causes of long-term mortality were complications and comorbidities.
Abstract
<h4>Background</h4>Ischemic stroke (IS) remains a major cause of mortality and disability worldwide, although the causes of death after stroke have changed. Long-term mortality data from low- and middle-income countries are limited. We investigated the fatality rates and causes of death in patients with IS in Thailand within and beyond 30 days post-discharge.<h4>Methods</h4>We conducted a retrospective descriptive study using national hospital database records from 2004-2022. Patients with IS (ICD-10 code I63) were included without age or sex restrictions, with death status followed through 2022. The causes of death included stroke, complications, comorbidities, accidents, suicide, and unknown causes. Mortality was analyzed during hospitalization and ≤30 and >30 days post-discharge.<h4>Results</h4>Among 888,003 patients with IS, the overall mortality was 47.6%: in-hospital 6.4%; ≤30 days post-discharge 8.2%; and >30 days post-discharge 33.1%. Mortality rates increased notably with age, exceeding 80% in those aged > 85 years. Stroke caused most in-hospital (58.6%) and short-term deaths (29.1%), whereas long-term mortality was primarily due to complications (30.7%) and comorbidities (30.5%). The leading comorbid causes were heart disease, dementia, and neoplasm; while pneumonia and sepsis were the primary fatal complications. Age-related debility, COVID-19 infection, and cardiovascular collapse were other major causes.<h4>Conclusion</h4>This nationwide study revealed dynamic changes in post-IS causes, with stroke predominating early deaths, while complications and comorbidities determined long-term outcomes. These findings highlight the need for integrated acute and post-discharge stroke care strategies targeting infection prevention, comorbidity management, and elder care.
Background
The study addresses the long-term mortality and causes of death in ischemic stroke patients, a significant public health issue. Previous research has indicated that the causes of death after stroke can vary, particularly in low- and middle-income countries. Understanding these causes is crucial for improving post-stroke care and outcomes.
Methods
This was a retrospective descriptive study utilizing national hospital database records from 2004 to 2022. The study included patients diagnosed with ischemic stroke (ICD-10 code I63) without age or sex restrictions, tracking death status through 2022. Mortality was analyzed during hospitalization and in two post-discharge timeframes: ≤30 days and >30 days.
Results
The overall mortality rate was 47.6%, with in-hospital mortality at 6.4%, ≤30 days post-discharge at 8.2%, and >30 days post-discharge at 33.1%. Stroke was responsible for 58.6% of in-hospital deaths and 29.1% of deaths within 30 days. Long-term mortality was attributed mainly to complications (30.7%) and comorbidities (30.5%).
Interpretation
The findings indicate a shift in causes of death from stroke itself to complications and comorbidities over time. While the mortality rates are statistically significant, the clinical implications may vary based on individual patient circumstances. Limitations include the retrospective nature of the study and potential confounding factors not accounted for.
Key findings
- Overall mortality was 47.6% among 888,003 patients with ischemic stroke.
- In-hospital mortality was 6.4%, ≤30 days post-discharge was 8.2%, and >30 days post-discharge was 33.1%.
- Stroke caused 58.6% of in-hospital deaths and 29.1% of short-term deaths.
- Long-term mortality was primarily due to complications (30.7%) and comorbidities (30.5%).
- Mortality rates exceeded 80% in patients aged > 85 years.
Limitations
- Retrospective study design.
- Relies on hospital database records, which may miss relevant data.
- Findings may not be generalizable to populations outside of Thailand.