Abstract
Failure to deliver the standard stroke care is suspected to be a potential reason for disproportionately high mortality among patients with co-morbid bipolar disorder (BD). Few studies have explored adverse outcomes and medical care costs concurrently (as a proxy for care intensity) among patients with BD admitted for stroke. Data for this nationwide population-based study were extracted from the Taiwan National Health Insurance Research Database, on 580 patients with BD hospitalized for stroke (the study group) and a comparison group consisting of randomly selected 1740 stroke patients without BD matched by propensity scores. Conditional logistic regression was used to estimate odds ratios (OR) for adverse in-hospital outcomes between study group and comparison group. We found that stroke patients with BD had significantly lower in-hospital mortality (3.28% vs. 5.63%), acute respiratory failure (2.59% vs. 5.57%), and use of mechanical ventilation (6.55% vs. 10.23%) than the comparison group. After adjusting for geographical location, urbanization level, monthly income, hypertension, diabetes, hyperlipidemia, and coronary heart disease, the odds of in-hospital mortality, acute respiratory failure, and use of mechanical ventilation in the BD group were 0.56 (95% CI: 0.34–0.92), 0.46 (95% CI: 0.26–0.80), and 0.63 (95% CI: 0.44–0.91), respectively. No differences were found in hospitalization costs and the length of hospital stay. With comparable hospitalization costs and length of hospital stay, we concluded that stroke patients with BD had lower in-hospital mortality and serious adverse events compared to stroke patients without BD.
Highlights
Bipolar disorder (BD) is a serious mental illness causing a high degree of medical burden during the course of illness and with the aging process [1]
Given the use of propensity-score matching, the two groups were similar on most characteristics: mean ages of the study group and comparison group were 62.3±14.8 and 62.0±14.7 years, respectively (p = 0.63), with no difference in sex, urbanization level, hypertension, hyperlipidemia, diabetes, and coronary heart disease distribution
Of the 580 patient with BD, 26.8%, 24.0%, 16.5%, 13.8% and 18.9% were diagnosed with bipolar affective disorder, depressed (ICD-9-CM code 296.5), bipolar affective disorder, manic (ICD-9-CM code 296.4), bipolar affective disorder, mixed (ICD-9-CM code 296.6) manic-depressive psychosis, unspecified (ICD-9-CM code 296.80) and others (ICD-9-CM codes 296.0, 296.7 or 296.89), respectively
Summary
Bipolar disorder (BD) is a serious mental illness causing a high degree of medical burden during the course of illness and with the aging process [1]. Among the medical causes of excessive and premature mortality deaths among BD patients, cardiovascular diseases are recognized as the leading cause, reported in both Western and Eastern studies [4,5,6,7]. Stroke is a cardiovascular disease with a high risk of mortality and long-term disability [8,9]. General population studies have shown that obesity, diabetes, dyslipidemia, hypertension, cigarette smoking, and alcohol abuse are the major risk factors for stroke [10]. Studies suggest that patients with BD are more susceptible to develop or have the stroke risk factors than the general population [11,12,13,14,15]. One proposed reason is suspected to be suboptimal medical care of metabolic and vascular diseases in patients with BD [16,17,18,19,20]
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