Abstract：
Few studies have assessed the sex-specific and age-specific risk of aspiration pneumonia (AP) in patients with stroke and evaluated whether mental disorders may increase this risk. In this population-based cohort study, we investigated the sex-specific and age-specific risk of AP in association with stroke and the joint effects of stroke and mental disorders on the risk of AP.
We included 23,288 patients with incident stroke admitted between 2005 and 2017 and 68,675 matched nonstroke controls. Information on mental disorders was obtained from medical claims data within the 3 years before the stroke incidence. Cox proportional hazards models considering death as a competing risk event were constructed to estimate the hazard ratio of AP incidence by the end of 2018 associated with stroke and selected mental disorders.
After ≤14 years of follow-up, AP incidence was higher in the patients with stroke than in the controls (11.30/1000 vs. 1.51/1000 person-years), representing a covariate-adjusted subdistribution hazard ratio (sHR) of 3.64, with no significant sex difference. The sHR significantly decreased with increasing age in both sexes. Stratified analyses indicated schizophrenia but not depression or bipolar affective disorder increased the risk of AP in the patients with stroke.
Compared with their corresponding counterparts, the patients with schizophrenia only, stroke only, and both stroke and schizophrenia had a significantly higher sHR of 4.01, 5.16, and 8.01, respectively. The risk of AP was higher in younger stroke patients than those older than 60 years. Moreover, schizophrenia was found to increase the risk of AP in patients with stroke.
We included 23,288 patients with incident stroke admitted between 2005 and 2017 and 68,675 matched nonstroke controls. Information on mental disorders was obtained from medical claims data within the 3 years before the stroke incidence. Cox proportional hazards models considering death as a competing risk event were constructed to estimate the hazard ratio of AP incidence by the end of 2018 associated with stroke and selected mental disorders.
After ≤14 years of follow-up, AP incidence was higher in the patients with stroke than in the controls (11.30/1000 vs. 1.51/1000 person-years), representing a covariate-adjusted subdistribution hazard ratio (sHR) of 3.64, with no significant sex difference. The sHR significantly decreased with increasing age in both sexes. Stratified analyses indicated schizophrenia but not depression or bipolar affective disorder increased the risk of AP in the patients with stroke.
Compared with their corresponding counterparts, the patients with schizophrenia only, stroke only, and both stroke and schizophrenia had a significantly higher sHR of 4.01, 5.16, and 8.01, respectively. The risk of AP was higher in younger stroke patients than those older than 60 years. Moreover, schizophrenia was found to increase the risk of AP in patients with stroke.
摘要：
很少有研究评估中风患者吸入性肺炎（AP）的性别特异性和年龄特异性风险，并评估精神障碍是否会增加这种风险。在这项基于人群的队列研究中，我们调查了与卒中相关的AP的性别特异性和年龄特异性风险,以及卒中和精神障碍对AP风险的联合影响.
我们纳入了2005年至2017年间收治的23,288例卒中事件患者和68,675例匹配的非卒中对照。有关精神障碍的信息是从中风发病前3年内的医疗索赔数据中获得的。构建了将死亡视为竞争性风险事件的Cox比例风险模型，以估计到2018年底与中风和选定精神障碍相关的AP发病率的风险比。
经过≤14年的随访，中风患者的AP发生率高于对照组（11.30/1000vs.1.51/1000人年)，代表协变量调整后的子分布风险比（sHR）为3.64，没有显着的性别差异。男女的sHR随年龄的增加而显着降低。分层分析表明，精神分裂症而不是抑郁症或双相情感障碍会增加中风患者AP的风险。
与相应的同行相比，只有精神分裂症患者，仅中风，卒中和精神分裂症的sHR分别为4.01、5.16和8.01。年轻卒中患者的AP风险高于60岁以上患者。此外，精神分裂症被发现增加中风患者AP的风险。
我们纳入了2005年至2017年间收治的23,288例卒中事件患者和68,675例匹配的非卒中对照。有关精神障碍的信息是从中风发病前3年内的医疗索赔数据中获得的。构建了将死亡视为竞争性风险事件的Cox比例风险模型，以估计到2018年底与中风和选定精神障碍相关的AP发病率的风险比。
经过≤14年的随访，中风患者的AP发生率高于对照组（11.30/1000vs.1.51/1000人年)，代表协变量调整后的子分布风险比（sHR）为3.64，没有显着的性别差异。男女的sHR随年龄的增加而显着降低。分层分析表明，精神分裂症而不是抑郁症或双相情感障碍会增加中风患者AP的风险。
与相应的同行相比，只有精神分裂症患者，仅中风，卒中和精神分裂症的sHR分别为4.01、5.16和8.01。年轻卒中患者的AP风险高于60岁以上患者。此外，精神分裂症被发现增加中风患者AP的风险。
