Incidence and Trends in Ischemic Stroke and Mortality in Patients with and Without Type 2 Diabetes in Taiwan 2000-2018

BACKGROUND Stroke has a significant impact on life expectancy, comparable to that of cardiovascular disease in Asia. We conducted this longitudinal study to examine the incidence of ischemic stroke and 30-day mortality among persons with and without type 2 diabetes (T2D). We also compared outcomes between those over and under 60 years and between men and women. METHODS We enrolled participants from the 2000 to 2018 National Health Insurance Research Database in Taiwan. Cox proportional-hazard models were used to examine the outcomes. RESULTS The incidence of in-hospital ischemic stroke in patients with and without T2D had significant reductions of 64.42% and 55.63%, respectively. The relative risk of stroke associated with diabetes remained significantly higher (2.01 to 2.33 times) than non-diabetes. The relative risk of stroke in patients under 60 with T2D was 2.56 to 4.36 times higher than in those without T2D. Between 2000 and 2018, there was a significant 83.24% and 88.55% reduction in the risk of 30-day mortality after stroke in patients with and without T2D. There was no significant increase in the risk of 30-day mortality in people with diabetes compared to those without diabetes. However, the relative risk of death from stroke in patients under 60 years with diabetes was 1.63 to 2.49 times higher than in those without diabetes. CONCLUSIONS This nationwide cohort study showed that the incidence of in-hospital ischemic stroke and 30-day mortality in patients with and without T2D exhibited a significant decreasing trend from 2000 to 2018. Patients with T2D had about twice the relative risk of ischemic stroke compared to those without T2D.