Abstract
Background: Carotid endarterectomy (CEA) or stenting (CAS) decrease future stroke risk in patients with stroke due to carotid stenosis. Mental illness is pervasive in the U.S., and patients with psychiatric comorbidities experience inequities in treatment for a range of conditions, including stroke. We investigated whether comorbid psychiatric disease is associated with lower rates of CEA/CAS after stroke due to carotid stenosis. Methods: Ischemic stroke cases due to carotid artery disease were identified using ICD9-CM codes in the 2007-2011 Nationwide Inpatient Sample. Psychiatric disease was defined by ICD9-CM codes for secondary diagnoses of schizophrenia, bipolar disorder, depression, anxiety, or substance use disorders. Using logistic regression, we tested the association between psychiatric disease and CEA/CAS, controlling for demographic, clinical, and hospital factors. Results: In the 22,178 included stroke cases, CEA/CAS was used in 18.8% of those with, and 20.6% of those without, psychiatric disease ( p =0.02). The presence of any psychiatric disease was associated with significantly lower odds of CEA/CAS (OR 0.84, 95% CI 0.76-0.94; Table 1). When diagnoses were analyzed separately, schizophrenia (OR 0.60, 95% CI 0.41-0.88) and substance use disorders (OR 0.76, 95% CI 0.63-0.91) were each associated with significantly lower odds of CEA/CAS. Moreover, the odds of CEA/CAS decreased as the number of psychiatric comorbidities increased: the presence of one comorbidity was associated with 13% lower odds of CEA/CAS (OR 0.87, 95% CI 0.78-0.98), while more than one comorbidity was associated with nearly 40% lower odds of CEA/CAS (OR 0.61, 95% CI 0.46-0.81), compared to those without any psychiatric disease. Conclusions: The odds of carotid revascularization after stroke due to carotid stenosis is lower in patients with psychiatric comorbidities, particularly in those with schizophrenia, substance use disorders, or multiple psychiatric diagnoses.
Published Version
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