Interaction of Post-Traumatic Stress Disorder and Race on Readmissions after Stroke

Background There is limited research on outcomes of patients with post-traumatic stress disorder (PTSD) who also develop stroke, particularly regarding racial disparities. Our goal was to determine whether PTSD is associated with the risk of hospital readmission after stroke and if racial disparities existed. Methods The analytical sample consisted of all veterans receiving care in the Veterans Health Administration (VHA) who were identified as having a new stroke requiring inpatient treatment based on International Classification of Diseases codes. The retrospective cohort data was obtained from the VA Corporate Data Warehouse. The main outcome was any readmission to VHA. The hypothesis that PTSD is associated with readmission after stroke was tested using Cox regression adjusted for patient characteristics with PTSD as a time-varying covariate. Results Our final cohort consisted of 93,652 patients with inpatient stroke diagnosis and no prior VHA codes for stroke starting from 1999 with follow-up through 6-August-2022. Of these patients, 12,916 (13.8%) had comorbid PTSD. Of the final cohort, 16,896 patients (18.0%) with stroke were readmitted. Our fully-adjusted model for readmission found an interaction between African Americans (AA) and PTSD with a hazard ratio of 1.09 (95% CI 1.00-1.20; p<0.05). In stratified models, PTSD has a significant HR of 1.10 (1.02-1.18, p=0.01) for AA but not White veterans 1.05 (0.99-1.11, p=0.10). Conclusion Among AA Veterans who suffered stroke, pre-existing PTSD was associated with increased risk of readmission, which was not significant among White veterans. This study highlights the need to focus on high-risk groups to reduce readmissions after stroke. ### Competing Interest Statement The authors have declared no competing interest. ### Clinical Trial N/A ### Funding Statement Dr. Lin is supported by VA IK2 CX002104 and VA I21 RX003612. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Not Applicable The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Birmingham VA IRB approved the study. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Not Applicable I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Not Applicable I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Not Applicable Data are available from the authors upon reasonable request and with permission from the Veterans Affairs Research Offices.