gms | German Medical Science

10. Deutscher Kongress für Versorgungsforschung, 18. GAA-Jahrestagung

Deutsches Netzwerk Versorgungsforschung e. V.
Gesellschaft für Arzneimittelanwendungsforschung und Arzneimittelepidemiologie e. V.

20.-22.10.2011, Köln

Time-dependent impact of diabetes on mortality in patients after stroke: Survival in a population-based 5-year cohort in Germany

Meeting Abstract

  • author Andrea Icks - Institut für Public Health, Medizinische Fakultät, Heinrich-Heine-Universität, Düsseldorf, Germany
  • corresponding author presenting/speaker Heiner Claessen - Institut für Biometrie und Epidemiologie, Deutsches Diabetes Zentrum, Düsseldorf, Germany
  • author Stephan Morbach - Abteilung für Diabetologie und Angiologie, Marienkrankenhaus, Soest, Germany
  • author Gerd Glaeske - Zentrum für Sozialpolitik (ZeS), Universität, Bremen, Germany
  • author Falk Hoffmann - Zentrum für Sozialpolitik, Universität, Bremen, Germany

10. Deutscher Kongress für Versorgungsforschung. 18. GAA-Jahrestagung. Köln, 20.-22.10.2011. Düsseldorf: German Medical Science GMS Publishing House; 2011. Doc11dkvf215

doi: 10.3205/11dkvf215, urn:nbn:de:0183-11dkvf2154

Published: October 12, 2011

© 2011 Icks et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Background: To estimate the impact of diabetes on mortality in patients after first stroke event.

Materials and methods: Using claims data of a nationwide statutory health insurance fund (Gmünder ErsatzKasse, GEK), we assessed all deaths in a cohort of all 5,757 patients with a first stroke between 2005 and 2007 (69.3% male, mean age 68.1 years, 32.2% diabetic, 73.7%, 17.9% and 8.4% with ischaemic, haemorrhagic, or other types of stroke) up to 2009. Using Cox regression, we estimated time dependent hazard ratios (HR) to compare patients with and without diabetes.

Results: The cumulative 5 year mortality was 40.0% and 54.2% in diabetic as well as 32.3% and 38.1% in non-diabetic men and women, respectively. In males, mortality was significantly lower in diabetic compared to non-diabetic patients in the first 30 days (multiple-adjusted HR 0.67; 95% confidence interval 0.53–0.84). In the following time, the diabetes risk increased yielding crossed survival curves after about a quarter year (time-dependency of diabetes, p=0.008). In women, no significant time dependency was found (p=0.89). In the full model, risk factors for mortality were increasing age, haemorrhagic stroke, renal failure (only in men), the level of nursing care, and the number of prescribed medications. Stratifying for subtype of stroke, a lower mortality risk in diabetic subjects within the first 30 days was found only for haemorrhagic, not for ischemic strokes.

Conclusions: In this population-based study, we found a time dependent mortality risk of diabetes following first stroke in men, not in women. Possible explanations require further research and will be discussed.


Icks A, Scheer M, Genz J, Giani G, Glaeske G, Hoffmann F. Stroke in the diabetic and non-diabetic population in Germany. Relative and attributable risks, 2005-2007. J Diab Compl. 2011; 25: 90-6.