Association of diabetes and smoking with stroke subtypes and mortality in a Saudi cohort

Stroke is a leading cause of morbidity and mortality in Saudi Arabia, with its incidence projected to double by 2030. Diabetes and smoking are major modifiable risk factors. This study assessed their association with stroke type and mortality in a tertiary stroke unit.

We conducted a retrospective review of 336 adults admitted with acute ischemic or hemorrhagic stroke at King Fahad Hospital, Al Ahsa, between January 2023 and December 2024. Demographic characteristics, risk factors, stroke type, and mortality were analyzed using descriptive statistics and multivariable logistic regression.

Among 336 patients, 83.9% were younger than 65 years, 66.4% were male, and 86.6% had ischemic stroke. Overall mortality was 4.2%. Diabetes was present in 56.3% of patients, smoking in 21.4%, and both risk factors in 11.3%. Older age (>65 years) was independently associated with hemorrhagic stroke [odds ratio (OR) = 2.29, P = 0.041] and mortality (OR = 4.77, P = 0.013). Non-Saudi nationality was associated with higher odds of hemorrhagic stroke (OR = 2.52, P = 0.014) and mortality (OR = 9.64, P = 0.001). Diabetes independently increased mortality risk (OR = 5.49, P = 0.037). Smoking was not significantly associated with mortality because no deaths occurred among smokers.

Ischemic stroke predominated, and mortality was independently associated with older age, non-Saudi nationality, and diabetes. Given the low number of deaths and limited adjustment for confounders, these findings should be interpreted cautiously and validated in larger multicenter setudies.