Abstract Details

Title Spinal Cord Injuries & Disorders Are a Risk Factor for Ischemic Stroke in US Veterans

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) S16 - Stroke Management and Outcomes (1:12 PM-1:24 PM)

Poster/Presentation
Number 002

Background

Ischemic stroke risk is elevated with SCI/D based on data from Taiwan [Wu et al, Neurology. 2012;78:1051–1057]. Whether SCI/D increases ischemic stroke risk in US Veterans has been unconfirmed.

Objective

We evaluated whether spinal cord injuries and disorders (SCI/D) are a risk factor for ischemic stroke in US Veterans.

Design/Methods

Using a retrospective dual-cohort design, adjusted stroke incidence was estimated for Veterans with and without SCI/D between fiscal years 2017-2021 using Veterans Health Administration (VHA) and Medicare utilization data. Veterans with ischemic stroke were identified using ICD-10 codes for cerebral infarction or sequalae of cerebral infarction. Veterans with prior diagnoses of ischemic stroke or sequelae were excluded. Incidence rate ratios were estimated using Poisson regression models adjusted for Veteran characteristics including common stroke risk factors, and prescriptions for stroke-prophylactic medications (antiplatelet agents, antilipid agents, and anticoagulants) immediately preceding the retrospective observation period.

Results

Analyses included 560,314 Veterans. Adjusting for person-days in the 5-year period, 7.2% with SCI/D vs 5.7% without had a stroke [p < .001], reflecting an incidence rate ratio (IRR) of 1.27 [95%CI: 1.19 – 1.36]. Adjusting for age, sex, smoking, diabetes, hypertension, atrial fibrillation, race and ethnicity yielded a 26% higher stroke incidence with SCI/D than without [IRR 1.26, 95%CI: 1.17 – 1.35]. Further adjusting for stroke-prophylactic prescriptions yielded a 19% higher stroke incidence with SCI/D than without [IRR 1.19, 95%CI: 1.11-1.27]. Compared to controls, stroke incidence was 50% and 31% higher with high and low tetraplegia, respectively [IRR 1.50, 95%CI: 1.16 – 1.92 and IRR 1.31, 95%CI: 1.02 – 1.67]. Stroke incidence was 36% higher with non-traumatic SCI/D [IRR 1.36, 95%CI: 1.24-1.49], whereas stroke incidence with traumatic SCI was not significantly higher than controls [IRR 1.05, 95%CI: 0.95-1.17].

Conclusions

SCI/D is a risk factor for ischemic stroke in US Veterans, especially for Veterans with tetraplegia and non-traumatic injuries.

Authors/Disclosures
Rafer Willenberg, MD, PhD (VA Boston Healthcare West Roxbury Campus) PRESENTER	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 (Edward Hines Jr. VA Hospital)	No disclosure on file
Kevin Stroupe	The institution of Kevin Stroupe has received research support from The Department of Veterans Affairs. Kevin Stroupe has received personal compensation in the range of $100,000-$499,999 for serving as a full-time employee with The Department of Veterans Affairs.
Jennifer Sippel (US Department of Veterans Affairs--SCI/D National Program Office)	Jennifer Sippel has nothing to disclose.
Charlesnika Evans (Hines VA)	Charlesnika Evans has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Association for Professionals in Infection Control. The institution of Charlesnika Evans has received research support from Veterans Affairs.
Zhiping Huo	Zhiping Huo has nothing to disclose.
Sunil Sabharwal (VA Boston HCS/ Harvard Medical School)	No disclosure on file