Suicidal drug overdose following stroke in elderly patients: a retrospective population-based cohort study

Figures & data

Figure 1 Flow diagram summarizing the process of enrollment and follow-up.

Abbreviation: SDO, suicidal drug overdose.

Table 1 Demographic profile of study patients (N=22,770)

Variables	Stroke	Nonstroke	t/χ^2	p-value
	(n=11,385)	(n=11,385)
Age (years)	73.41±8.18	73.41±8.18	0.000	1.000
60–69	4,024 (35.3)	4,024 (35.3)	0.000	1.000
70–79	4,527 (39.8)	4,527 (39.8)
80–89	2,531 (22.1)	2,531 (22.1)
90–99	303 (2.7)	303 (2.7)
Men	6,234 (54.8)	6,234 (54.8)	0.000	1.000
Follow-up (years)	5.06±3.30	5.60±3.29	−12.352	<0.001
Mental health diagnosis
Insomnia	2,659 (23.4)	2,310 (20.3)	31.355	<0.001
Depressive disorders	1,047 (9.2)	875 (7.7)	16.811	<0.001
Dementia	989 (8.7)	568 (5.0)	122.190	<0.001
Substance use disorders	175 (1.5)	111 (1.0)	14.504	<0.001
Alcohol use disorders	226 (2.0)	89 (0.8)	60.420	<0.001
Bipolar disorders	68 (0.6)	58 (0.5)	0.798	0.372
Psychotic disorders	59 (0.5)	49 (0.4)	0.930	0.335
Major coexisting diseases
Hypertension	10,075 (88.5)	7,053 (61.9)	2,151.851	<0.001
Diabetes	4,960 (43.6)	3,044 (26.7)	707.268	<0.001
Coronary disease	5,091 (44.7)	3,753 (33.0)	330.979	<0.001
COPD	4,933 (43.3)	4,051 (35.6)	143.018	<0.001
Chronic kidney disease	2,696 (23.7)	1,916 (16.8)	165.423	<0.001
Asthma	1,950 (17.1)	1,484 (13.0)	74.468	<0.001
Fracture	2,791 (24.5)	2,357 (20.7)	47.277	<0.001
Osteoporosis	2,446 (21.5)	2,170 (19.1)	20.699	<0.001
Hyperlipidemia	2,792 (24.5)	2,028 (17.8)	153.617	<0.001
Charlson comorbidity score	1.42±1.61	0.75±1.44	32.856	<0.001

Note: Data shown as mean ± standard deviation or n (%).

Abbreviation: COPD, chronic obstructive pulmonary disease.

Figure 2 Cumulative incidence of SDO in elder patients with stroke and the matched cohort.

Abbreviation: SDO, suicidal drug overdose.

Figure 3 Cumulative incidence of SDO in elder stroke patients with different stroke attacks.

Abbreviation: SDO, suicidal drug overdose.

Table 2 Incidences and HRs for SDO following stroke (2002–2012, N=22,770)

SDO during follow-up	Total sample	Comparison group	Stroke group
Incidence of stroke (per 1,000 person-years)	2.64	1.32	3.31
No of occurrences	275	84	191
Observed person-years	121,416.75	63,779.68	57,637.07
Crude HR (95% CI)		1.00	2.476 (1.915–3.200)*
aHR (95% CI)a		1.00	2.288 (1.746–2.999)*

Notes:

a Adjusted for age, sex, mental health diagnosis, and major coexisting diseases.

* p<0.001.

Abbreviations: HR, hazard ratio; SDO, suicidal drug overdose; CI, confidence interval; aHR, adjusted hazard ratio.

Figure 4 Cumulative incidence of SDO in four groups: poststroke depression, prestroke depression, stroke without depression, and nonstroke-matched control groups.

Abbreviation: SDO, suicidal drug overdose.

Table 3 Univariate and multivariate survival analyses for factors associated with SDO in patients with stroke

Variables	Univariate analysis			Multivariate analysis
	HR	95% CI of HR	p-value	aHR	95% CI of aHR	p-value
Age (years)	1.007	0.989–1.025	0.473	1.000	0.981–1.020	0.992
Sex
Men	1.000
Women	0.988	0.743–1.313	0.933	0.975	0.718–1.323	0.869
Mental health diagnosis
Insomnia	1.244	0.899–1.722	0.188	1.101	0.781–1.552	0.584
Depressive disorders	1.735	1.155–2.607	0.008	1.543	1.001–2.378	0.050
Dementia	1.522	0.966–2.397	0.070	1.356	0.841–2.189	0.212
Substance use disorders	0.825	0.205–3.324	0.787	0.846	0.191–3.743	0.825
Alcohol use disorders	0.875	0.280–2.738	0.819	0.938	0.278–3.169	0.919
Bipolar disorders	2.018	0.501–8.130	0.323	1.325	0.318–5.522	0.699
Psychotic disorders	2.130	0.529–8.578	0.288	1.662	0.402–6.865	0.483
Major coexisting diseases
Hypertension	0.994	0.643–1.537	0.978	0.882	0.563–1.383	0.584
Diabetes	1.179	0.887–1.568	0.256	1.227	0.909–1.657	0.181
Coronary disease	1.614	1.213–2.147	0.001	1.617	1.193–2.913	0.002
COPD	1.254	0.944–1.665	0.119	1.267	0.912–1.762	0.158
Chronic kidney disease	0.850	0.593–1.217	0.375	0.748	0.515–1.088	0.128
Asthma	0.952	0.645–1.406	0.806	0.749	0.483–1.160	0.195
Fracture	0.897	0.630–1.276	0.544	0.892	0.615–1.295	0.549
Osteoporosis	0.860	0.596–1.242	0.422	0.798	0.532–1.198	0.276
Hyperlipidemia	0.877	0.617–1.247	0.466	0.798	0.554–1.148	0.223

Abbreviations: SDO, suicidal drug overdose; HR, hazard ratio; CI, confidence interval; aHR, adjusted hazard ratio; COPD, chronic obstructive pulmonary disease.

Figure 5 Follow-up duration among 191 elder stroke patients who developed SDO.

Abbreviation: SDO, suicidal drug overdose.