One-year readmission and mortality following ischaemic stroke by diabetes status, sex, and socioeconomic disadvantage: An analysis of 27,802 strokes from 2012 to 2017

Objective: We estimated the 1-year incidence of readmission to hospital and 1-year all-cause mortality following ischaemic stroke (IS), by diabetes status, sex, and socioeconomic disadvantage. 

Methods: This study included all individuals aged ≥30 years who were discharged from hospital following an IS between July 2012 and June 2017 in Victoria, Australia (n = 25,421). Individuals were followed from discharge until readmission (for all-causes, cardiovascular readmission, and readmission for IS) or death, censoring at 1-year of follow-up. 

Results: The 1-year cumulative incidence of all-cause readmission following an IS was 56.1% (95% CI: 55.5–56.7); 24% of first all-cause admission were attributed to cardiovascular disease. People with diabetes were at an excess risk of all-cause, cardiovascular, and IS readmission following an IS (adjusted sub-HRs: 1.13 [95% CI: 1.09–1.17], 1.14 [1.07–1.21], and 1.17 [1.06–1.29], for people with vs. without diabetes, respectively) and 1-year mortality (adjusted HR: 1.11 [1.03–1.19]). There was no significant difference between men and women in all-cause and cardiovascular readmission risk, while women were at higher risk of IS readmission (sub-HR: 1.10 [1.01–1.21] for women vs. men) and mortality (HR: 1.12 [1.05–1.20]). There was no relationship between socioeconomic disadvantage and risk of cardiovascular or IS readmission, while 1-year mortality risk did increase with increasing socioeconomic disadvantage (HR for most vs. least disadvantaged quintile: 1.15 [1.03–1.27]; p_trend = 0.006), and all-cause readmission risk decreased (sub-HR: 0.94 [0.90–0.99]; p_trend = 0.001). 

Conclusions: There is a high risk of readmission following IS. Decreasing the readmission rate will require more complex interventions than solely improving post-discharge cardiovascular management.