The association between comorbid anxiety disorders and the risk of stroke among patients with diabetes: An 11-year population-based retrospective cohort study

Meng Ting Tsai, Steven R. Erickson, Lawrence J. Cohen, Chung Hsuen Wu

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background Diabetes and anxiety disorders are independent risk factors for stroke. However, it remains unclear whether the risk of stroke is higher among diabetic patients with comorbid anxiety than without comorbid anxiety. Therefore, the purpose of this study was to investigate the association between comorbid anxiety and the risk of stroke among patients with diabetes. Methods This is a retrospective cohort study. We used the National Health Insurance Research Database in Taiwan to identify a diabetes cohort with a new diagnosis of an anxiety disorder but without a history of stroke. The enrollment period was 2001–2006 with up to 11 years of follow-up data. Comorbid anxiety was defined by both a clinical diagnosis of the DSM-IV (ICD-9-CM) and prescriptions for anxiolytic medications. Propensity score matching was performed to balance the selected confounders between the anxiety-exposed group and anxiety non-exposed group. Cox-propositional hazard regression models were used to evaluate the association between comorbid anxiety and the risk of stroke. Results Among patients with diabetes (N=40,846), an estimated 5.8% (N=2374) of patients had comorbid anxiety disorders. Diabetic patients with comorbid anxiety were significantly associated with a higher risk of stroke compared to patients without comorbid anxiety (hazard ratio: 1.33, 95% confidence interval: 1.02–1.72). Limitations The severity of anxiety or diabetes could not be measured from the claims data. Residual confounding may still exist. Conclusion A significantly elevated risk of stroke was observed in association with comorbid anxiety among patients with diabetes. Psychiatrists should consider routine screening for anxiety disorders to prevent a stroke event among patients with diabetes.

Original languageEnglish
Pages (from-to)178-186
Number of pages9
JournalJournal of Affective Disorders
Volume202
DOIs
StatePublished - 15 Sep 2016

Fingerprint

Anxiety Disorders
Cohort Studies
Anxiety
Retrospective Studies
Stroke
Population
Propensity Score
Anti-Anxiety Agents
National Health Programs
International Classification of Diseases
Taiwan
Proportional Hazards Models
Diagnostic and Statistical Manual of Mental Disorders
Prescriptions
Psychiatry
Databases
Confidence Intervals

Keywords

  • Administrative claims data
  • Anxiety
  • Comorbidity
  • Diabetes
  • National Health Insurance Research Database (NHIRD)
  • Stroke

Cite this

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title = "The association between comorbid anxiety disorders and the risk of stroke among patients with diabetes: An 11-year population-based retrospective cohort study",
abstract = "Background Diabetes and anxiety disorders are independent risk factors for stroke. However, it remains unclear whether the risk of stroke is higher among diabetic patients with comorbid anxiety than without comorbid anxiety. Therefore, the purpose of this study was to investigate the association between comorbid anxiety and the risk of stroke among patients with diabetes. Methods This is a retrospective cohort study. We used the National Health Insurance Research Database in Taiwan to identify a diabetes cohort with a new diagnosis of an anxiety disorder but without a history of stroke. The enrollment period was 2001–2006 with up to 11 years of follow-up data. Comorbid anxiety was defined by both a clinical diagnosis of the DSM-IV (ICD-9-CM) and prescriptions for anxiolytic medications. Propensity score matching was performed to balance the selected confounders between the anxiety-exposed group and anxiety non-exposed group. Cox-propositional hazard regression models were used to evaluate the association between comorbid anxiety and the risk of stroke. Results Among patients with diabetes (N=40,846), an estimated 5.8{\%} (N=2374) of patients had comorbid anxiety disorders. Diabetic patients with comorbid anxiety were significantly associated with a higher risk of stroke compared to patients without comorbid anxiety (hazard ratio: 1.33, 95{\%} confidence interval: 1.02–1.72). Limitations The severity of anxiety or diabetes could not be measured from the claims data. Residual confounding may still exist. Conclusion A significantly elevated risk of stroke was observed in association with comorbid anxiety among patients with diabetes. Psychiatrists should consider routine screening for anxiety disorders to prevent a stroke event among patients with diabetes.",
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The association between comorbid anxiety disorders and the risk of stroke among patients with diabetes : An 11-year population-based retrospective cohort study. / Tsai, Meng Ting; Erickson, Steven R.; Cohen, Lawrence J.; Wu, Chung Hsuen.

In: Journal of Affective Disorders, Vol. 202, 15.09.2016, p. 178-186.

Research output: Contribution to journalArticle

TY - JOUR

T1 - The association between comorbid anxiety disorders and the risk of stroke among patients with diabetes

T2 - An 11-year population-based retrospective cohort study

AU - Tsai, Meng Ting

AU - Erickson, Steven R.

AU - Cohen, Lawrence J.

AU - Wu, Chung Hsuen

PY - 2016/9/15

Y1 - 2016/9/15

N2 - Background Diabetes and anxiety disorders are independent risk factors for stroke. However, it remains unclear whether the risk of stroke is higher among diabetic patients with comorbid anxiety than without comorbid anxiety. Therefore, the purpose of this study was to investigate the association between comorbid anxiety and the risk of stroke among patients with diabetes. Methods This is a retrospective cohort study. We used the National Health Insurance Research Database in Taiwan to identify a diabetes cohort with a new diagnosis of an anxiety disorder but without a history of stroke. The enrollment period was 2001–2006 with up to 11 years of follow-up data. Comorbid anxiety was defined by both a clinical diagnosis of the DSM-IV (ICD-9-CM) and prescriptions for anxiolytic medications. Propensity score matching was performed to balance the selected confounders between the anxiety-exposed group and anxiety non-exposed group. Cox-propositional hazard regression models were used to evaluate the association between comorbid anxiety and the risk of stroke. Results Among patients with diabetes (N=40,846), an estimated 5.8% (N=2374) of patients had comorbid anxiety disorders. Diabetic patients with comorbid anxiety were significantly associated with a higher risk of stroke compared to patients without comorbid anxiety (hazard ratio: 1.33, 95% confidence interval: 1.02–1.72). Limitations The severity of anxiety or diabetes could not be measured from the claims data. Residual confounding may still exist. Conclusion A significantly elevated risk of stroke was observed in association with comorbid anxiety among patients with diabetes. Psychiatrists should consider routine screening for anxiety disorders to prevent a stroke event among patients with diabetes.

AB - Background Diabetes and anxiety disorders are independent risk factors for stroke. However, it remains unclear whether the risk of stroke is higher among diabetic patients with comorbid anxiety than without comorbid anxiety. Therefore, the purpose of this study was to investigate the association between comorbid anxiety and the risk of stroke among patients with diabetes. Methods This is a retrospective cohort study. We used the National Health Insurance Research Database in Taiwan to identify a diabetes cohort with a new diagnosis of an anxiety disorder but without a history of stroke. The enrollment period was 2001–2006 with up to 11 years of follow-up data. Comorbid anxiety was defined by both a clinical diagnosis of the DSM-IV (ICD-9-CM) and prescriptions for anxiolytic medications. Propensity score matching was performed to balance the selected confounders between the anxiety-exposed group and anxiety non-exposed group. Cox-propositional hazard regression models were used to evaluate the association between comorbid anxiety and the risk of stroke. Results Among patients with diabetes (N=40,846), an estimated 5.8% (N=2374) of patients had comorbid anxiety disorders. Diabetic patients with comorbid anxiety were significantly associated with a higher risk of stroke compared to patients without comorbid anxiety (hazard ratio: 1.33, 95% confidence interval: 1.02–1.72). Limitations The severity of anxiety or diabetes could not be measured from the claims data. Residual confounding may still exist. Conclusion A significantly elevated risk of stroke was observed in association with comorbid anxiety among patients with diabetes. Psychiatrists should consider routine screening for anxiety disorders to prevent a stroke event among patients with diabetes.

KW - Administrative claims data

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