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Causes of Death in Different Subtypes of Ischemic and Hemorrhagic Stroke
Chi-Hung Liu1, Jr-Rung Lin2, Chia-Wei Liou3
11 Stroke Center and Department of Neurology, Chang Gung Memorial Hospital, Linkou Medical Center and College of Medicine, Chang Gung University, Taoyuan, Taiwan.
Insights
Hemorrhagic stroke patients had higher mortality than ischemic stroke patients. After the first year, cancer became a leading cause of death in ischemic stroke survivors, even without prior cancer history.
Area of Science:
- Neurology
- Public Health
- Epidemiology
Background:
- Causes of death following ischemic stroke (IS) and hemorrhagic stroke (HS) require further investigation.
- Understanding mortality patterns is crucial for improving patient outcomes and healthcare strategies.
Purpose of the Study:
- To comprehensively analyze the causes of death in first-ever ischemic and hemorrhagic stroke patients.
- To compare mortality rates and leading causes of death between IS and HS subtypes.
Main Methods:
- A cohort of 11,215 first-ever stroke patients was enrolled from 2008-2011.
- Data were linked to the national death registry to determine causes of mortality.
- Mortality rates and causes were assessed for IS and HS subtypes.
Main Results:
- Hemorrhagic stroke patients exhibited significantly higher overall mortality than ischemic stroke patients (32.0% vs 18.1%).
- In ischemic stroke, large artery atherosclerosis and cardioembolism subtypes showed the highest mortality (40.7%).
- Stroke was the primary cause of death within the first year for both IS and HS. Subsequently, cancer emerged as the leading cause of death in IS, and remained a significant cause in both stroke types, irrespective of prior cancer history.
Conclusions:
- Hemorrhagic stroke carries a higher mortality risk compared to ischemic stroke.
- Cancer is a significant cause of late mortality in stroke survivors, particularly in specific ischemic stroke subtypes.
- Long-term survival strategies for stroke patients should address both stroke recurrence and comorbid conditions like cancer.
Abstract:
Causes of death in both ischemic stroke (IS) and hemorrhagic stroke (HS) subtypes are not comprehensively studied. Between 2008 and 2011, we enrolled 11 215 first-ever stroke patients from the Stroke Registry of Chang-Gung Healthcare System and linked these data to the national death registry. The main causes of death in each stroke subtype were assessed. Patients with HS had higher overall mortality than IS (32.0% vs 18.1%, P < .001). In IS subtypes, large-artery atherosclerosis plus cardioembolism had the worst mortality (40.7%, P < .001). Stroke was the leading cause of death in both IS and HS within the first year. Stroke remained the major cause of death in HS, but cancer was the leading cause of death in IS after the first year. After excluding the patients with previous cancer history, cancer was still an important cause of death in IS and HS, particularly in the IS subtypes of small vessel occlusion, stroke of undetermined etiology, and transient ischemic attack.
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