Patients with stroke and psychiatric comorbidities have lower carotid revascularization rates

Area of Science:

• Neurology
• Psychiatry
• Health Services Research

Background:

• Stroke due to carotid stenosis is a significant cause of disability.
• Carotid endarterectomy (CEA) and carotid artery stenting (CAS) are established revascularization procedures.
• The impact of mental illness on access to these procedures is not well understood.

Purpose of the Study:

• To investigate the association between mental illness and the rates of CEA/CAS following stroke.
• To identify specific psychiatric conditions that may influence treatment decisions.

Main Methods:

• Retrospective cross-sectional study using the 2007-2014 Nationwide Inpatient Sample.
• Identified ischemic stroke cases due to carotid stenosis.
• Defined psychiatric conditions using ICD-9-CM codes for schizophrenia/psychoses, bipolar disorder, depression, anxiety, and substance use disorders.
• Employed logistic regression to analyze the association between psychiatric conditions and CEA/CAS, controlling for covariates.

Main Results:

• 18.5% of 37,474 stroke cases had a psychiatric comorbidity.
• Any psychiatric condition was associated with lower odds of CEA/CAS (aOR 0.84, 95% CI 0.78-0.90).
• Schizophrenia/psychoses (aOR 0.72), depression (aOR 0.83), and substance use disorders (aOR 0.73) were significantly associated with lower CEA/CAS rates.
• A dose-dependent relationship was observed, with multiple psychiatric comorbidities showing lower odds of CEA/CAS compared to single diagnoses (p-trend <0.001).

Conclusions:

• Patients with mental illness, particularly schizophrenia/psychoses, depression, and substance use disorders, are less likely to undergo carotid revascularization after stroke.
• The reduced likelihood of receiving CEA/CAS increases with the number of psychiatric diagnoses.
• Further research is needed to understand the underlying reasons for these disparities in care.