Incidence and Trends in Ischemic Stroke and Mortality in Patients with and Without Type 2 Diabetes in Taiwan 2000-2018

BACKGROUND Stroke has a significant impact on life expectancy, comparable to that of cardiovascular disease in Asia. We conducted this longitudinal study to examine the incidence of ischemic stroke and 30-day mortality among persons with and without type 2 diabetes (T2D). We also compared outcomes between those over and under 60 years and between men and women. METHODS We enrolled participants from the 2000 to 2018 National Health Insurance Research Database in Taiwan. Cox proportional-hazard models were used to examine the outcomes. RESULTS The incidence of in-hospital ischemic stroke in patients with and without T2D had significant reductions of 64.42% and 55.63%, respectively. The relative risk of stroke associated with diabetes remained significantly higher (2.01 to 2.33 times) than non-diabetes. The relative risk of stroke in patients under 60 with T2D was 2.56 to 4.36 times higher than in those without T2D. Between 2000 and 2018, there was a significant 83.24% and 88.55% reduction in the risk of 30-day mortality after stroke in patients with and without T2D. There was no significant increase in the risk of 30-day mortality in people with diabetes compared to those without diabetes. However, the relative risk of death from stroke in patients under 60 years with diabetes was 1.63 to 2.49 times higher than in those without diabetes. CONCLUSIONS This nationwide cohort study showed that the incidence of in-hospital ischemic stroke and 30-day mortality in patients with and without T2D exhibited a significant decreasing trend from 2000 to 2018. Patients with T2D had about twice the relative risk of ischemic stroke compared to those without T2D. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This study is supported in part by Taiwan Ministry of Health and Welfare Clinical Trial Center (MOHW112-TDU-B-212-144004), China Medical University Hospital (DMR-111-105; DMR-112-087), Taipei Veterans General Hospital (V111C-188, V112C-164, V113C-166), and National Science and Technology Council, R.O.C. (MOST 110-2314-B-075-027-MY3). ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The research was approved by the Research Ethics Committee of China Medical University and Hospital [CMUH111-REC2-109(CR-1)]. 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. Yes 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). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Data of this study are available from the National Health Insurance Research Database (NHIRD) published by Taiwan National Health Insurance (NHI) Administration. The data utilized in this study cannot be made available in the paper, the supplemental files, or in a public repository due to the ??Personal Information Protection Act?? executed by Taiwan government starting from 2012. Requests for data can be sent as a formal proposal to the NHIRD Office () or by email to stsung{at}mohw.gov.tw.