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Abstract Details

Incidence of Ischemic Stroke in US Veterans Living with Spinal Cord Injury: Preliminary Data
Cerebrovascular Disease and Interventional Neurology
S3 - Cerebrovascular Disease and Interventional Neurology: Diagnosis, Prognosis, and Population Health (1:48 PM-2:00 PM)

People with SCI/D have been reported to have an elevated risk of ischemic stroke, based on a study in the population of Taiwan [Wu et al, Neurology. 2012;78:1051–1057]. This prior study reported a cumulative incidence rate of ischemic stroke of 1.9% over 4 years subsequent to SCI, vs 0.6% in matched non-injured controls. 

In this preliminary study, we estimate the 4-year incidence of ischemic stroke and associated risk factors in United States (US) Veterans living with spinal cord injuries and disorders (SCI/D).

We used Department of Veterans Affairs (VA) administrative databases to examine the incidence of ischemic stroke between fiscal years 2018-2021. Veterans living with strokes were identified using ICD-9 or 10 codes for cerebral infarction or sequelae of cerebral infarction. Veterans with diagnoses of ischemic strokes or sequelae during 2013-2017 were excluded. Statistical analyses included frequencies and multiple regression models.

From FY 2018-2021, 394 of 12,547 Veterans living with SCI had a newly-recorded ischemic stroke, reflecting a 4-year incidence of 3.14%, and an average annual incidence of 0.79%. Compared to Veterans with a D injury classification by the American Spinal Injury Association (ASIA) Impairment Scale, Veterans with high tetraplegia had a higher likelihood of ischemic stroke (IRR=1.91, 95%CI: 1.37 – 2.67). Compared to Veterans with traumatic SCI, Veterans with non-traumatic SCI/D also had a higher likelihood of ischemic stroke (IRR = 1.43, 95%CI: 1.13 – 1.80).

US Veterans with SCI/D have a higher incidence of ischemic stroke than that reported for the Taiwanese population with SCI. Tetraplegia and a non-traumatic injury etiology seem to be SCI-centric risk factors. Further study will include comparison of stroke incidence to that of age- and sex-matched US Veterans without SCI.

Rafer Willenberg, MD, PhD (VA Boston Healthcare West Roxbury Campus)
The institution of Dr. Willenberg has received research support from Dept of Veterans Affairs. Dr. Willenberg has received personal compensation in the range of $100,000-$499,999 for serving as a physician with Dept of Veterans Affairs.
Bridget Smith, PhD (Edward Hines Jr. VA Hospital) The institution of Dr. Smith has received research support from Dept of Veterans Affairs .
Kevin Stroupe Kevin Stroupe has received research support from Department of Veterans Affairs.
Jennifer Sippel, PhD (US Department of Veterans Affairs--SCI/D National Program Office) Dr. Sippel has nothing to disclose.
Zhiping Huo Zhiping Huo has nothing to disclose.
Sunil Sabharwal, MD (VA Boston HCS/ Harvard Medical School) Dr. Sabharwal has received publishing royalties from a publication relating to health care.