PhD Student Aarhus University, Department of Clinical Epidemiology, Denmark
Background: Stroke patients using glucocorticoids have a higher mortality compared with stroke patients not using glucocorticoids. The underlying mechanisms are poorly understood.
Objectives: To characterize stroke patients using glucocorticoids regarding stroke severity, stroke treatment, comorbidity, co-medication, lifestyle, and socioeconomic position, and the association with all-cause mortality.
Methods: In a Danish nationwide population-based cohort study we identified all patients with first-time stroke during 2005-2017 (N = 79,110 with ischemic stroke and N = 10,520 with intracerebral hemorrhage). The exposure was preadmission use of systemic glucocorticoids (use up to 90 days prior to stroke, N= 3,455). Patients with former glucocorticoid use (use between 91 to 180 days prior to stroke, N = 1,285) and patients with non/rare use (N = 84,885) were included in comparison cohorts. Distributions of stroke severity, comorbidities, co-medication, markers of lifestyle and socioeconomic status were tabulated according to exposure status and type of stroke. Cohorts were followed from stroke diagnosis until death, emigration or up to one year following stroke. The Kaplan-Meier method was used to compute 30-day and 1-year mortality.
Results: 20% of all current glucocorticoid users had severe or very severe strokes compared to 17% of former and non/rare users according to the Scandinavian Stroke Scale Score. Prevalences of comorbidities (pulmonary, cardiovascular, gastrointestinal, renal, rheumatic and oncological) were similar among current and former users, but lower among non/rare users. Ever smoking was similar among current (55%), former users (56%) and non/rare users (54%), whereas alcohol intake above 14/21(women/men) units/week was slightly lower in current (6%) and former users (8%) compared with non/rare users (10%). Socioeconomic status was marginally lower among current and former users (low educational level in 47%, low income in 28-30%) compared with non/rare users (low educational level in 41%, low income in 24%). The 30-day mortality was higher among current users (15% [95% CI: 14%-16) compared with former (11% [95% CI: 9%-12) and non/rare users (8.2% [95% CI: 8.0%-8.4%]). Similarly, 1-year mortality was higher among current users (32% [95% CI: 30% - 33%]) compared with former (24% [95% CI: 21%-26%]) and non/rare users (17.1% [95% CI: 16.9%-17.4%]).
Conclusions: Stroke severity, prevalences of comorbidities, and socioeconomic position differed only slightly according to glucocorticoid exposure. We found an increased mortality among current glucocorticoid users compared with former and non/rare users. Future research should elucidate pathways for the increased mortality.
