Dataset Information

Does depression increase the risk of stroke in patients with rheumatoid arthritis? A population-based cohort study.

ABSTRACT:

Objectives

Comorbid depression is common and undertreated in patients with rheumatoid arthritis (RA). It remains uncertain whether comorbid depression provoked the risk of poor clinical outcome, stroke in particular, among patients with RA. This work aimed to determine if depression onset during the treatment process increases stroke risk for patients with RA as compared with those with (1) neither RA nor depression, (2) RA only and (3) depression only.

Design

A nationwide, population-based cohort study.

Setting

Taiwan's Longitudinal Health Insurance Database.

Participants

We identified 8045 subjects with a newly diagnosed RA between 1997 and 2010, together with 32?600 subjects without RA matched by age, gender and index date. All subjects were further divided into four groups based on whether they were diagnosed with comorbid depression during the follow-up period.

Main outcome measure

The incidence rate and HR for incident stroke were estimated by the end of 2012 using Cox proportional hazard regression.

Results

We discovered that patients with RA with the comorbid depression exhibited the highest risk of stroke, with an adjusted HR of 2.18 (95% CI 1.87 to 2.54). Those with RA only or those with depression only still had the higher risk of stroke by 43% and 57% as compared with subjects without either condition. Multivariate analysis showed RA subjects who were male or older, incurred the onset of depression, or had comorbidities such as hypertension, diabetes as well as heart disease, had a greater risk of stroke.

Conclusions

This study cleared up the significant association between RA and the subsequent risk of stroke, and further highlighted that the onset of depression within the treatment process may increase stroke risk for RA subjects. Findings could assist healthcare providers to pinpoint individuals with RA with a higher predisposition of stroke, which could facilitate the provision of appropriate rehabilitation.

SUBMITTER: Tsai TY

PROVIDER: S-EPMC5541340 | biostudies-literature | 2017 Jun

REPOSITORIES: biostudies-literature

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Publications

Does depression increase the risk of stroke in patients with rheumatoid arthritis? A population-based cohort study.

Tsai Tzung-Yi TY Lu Ming-Chi MC Livneh Hanoch H Chiu Shan-Yun SY Lai Ning-Sheng NS Guo How-Ran HR

BMJ open 20170622 4

<h4>Objectives</h4>Comorbid depression is common and undertreated in patients with rheumatoid arthritis (RA). It remains uncertain whether comorbid depression provoked the risk of poor clinical outcome, stroke in particular, among patients with RA. This work aimed to determine if depression onset during the treatment process increases stroke risk for patients with RA as compared with those with (1) neither RA nor depression, (2) RA only and (3) depression only.<h4>Design</h4>A nationwide, popula ...[more]

PMID: 28646083

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Project description:BackgroundPostpartum psychiatric disorders (PPD) are common complications of childbirth. A common explanation for their development is that the psychological, hormonal, and immune changes associated with pregnancy and parturition may trigger psychiatric symptoms postpartum. Rheumatoid arthritis (RA) is characterized by abnormalities in the activity of the hypothalamic-pituitary-adrenal axis and of the immune system, but its association with PPD is unknown. We analyzed whether women with RA before childbirth have an increased risk of PPD.MethodsWe conducted a large population-based cohort study including mothers of singleton births in the Danish (1995-2015), Finnish (1997-2013), and Swedish Medical Birth Registers (2001-2013) (N = 3,516,849). We linked data from the Medical Birth Registers with data from several national socioeconomic and health registers. Exposure was defined as having a diagnosis of RA before childbirth, while the main outcome was a clinical diagnosis of psychiatric disorders 90 days postpartum. We analyzed the association between RA and PPD using Cox proportional hazard models, stratified by a personal history of psychiatric disorders.ResultsAmong women without a history of psychiatric disorders, the PPD incidence rate was 32.2 in the exposed and 19.5 per 1000 person-years in the unexposed group; women with RA had a higher risk of overall PPD than their unexposed counterparts [adjusted hazard ratio (HR) = 1.52, 95% confidence intervals (CI) 1.17 to 1.98]. Similar associations were also observed for postpartum depression (HR = 1.65, 95% CI 1.09 to 2.48) and other PPD (HR = 1.59, 95% CI 1.13 to 2.24). Among women with a history of psychiatric disorders, the incidence rate of overall PPD was 339.6 in the exposed and 346.6 per 1000 person-years in the unexposed group; RA was not associated with PPD. We observed similar associations between preclinical RA (RA diagnosed after childbirth) and PPD to those corresponding to clinical RA.ConclusionsRheumatoid arthritis was associated with an increased PPD risk in women without, but not in those with a psychiatric history. If our findings are confirmed in future studies, new mothers with RA may benefit from increased surveillance for new-onset psychiatric disorders postpartum.

Dataset Information

Does depression increase the risk of stroke in patients with rheumatoid arthritis? A population-based cohort study.

Objectives

Design

Setting

Participants

Main outcome measure

Results

Conclusions

Publications

Does depression increase the risk of stroke in patients with rheumatoid arthritis? A population-based cohort study.

Similar Datasets

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