Abstract Details

Title The impact of prior multimorbidity on the long-term risk and costs of institutionalisation after stroke: a population-based study

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P1 - Poster Session 1 (9:00 AM-5:00 PM)

Poster/Presentation
Number 118

Objective To examine the impact of prior comorbidity and multimorbidity on the long-term risks and costs of institutionalisation following stroke.

Background Institutionalisation is common following stroke. However, the risks of institutionalisation vary between studies, and the influence of prior comorbidity or multimorbidity in predicting institutionalisation and its costs following stroke are unknown.

Design/Methods Patients from the population-based Oxford Vascular Study were ascertained from 2002-2018 and followed until 2020. Clinical information, including past medical history and prior comorbidities, was obtained as soon as possible following the index event through patient interviews and medical records. Comorbidity was defined as one Charlson Comorbidity Index (CCI) comorbidity, and multimorbidity was defined as two or more. Patients who were previously institutionalised were excluded. The 10-year risks of institutionalisation were determined using crude and adjusted Cox proportional hazard models. Mean, censor-adjusted 10-years costs of institutionalisation were calculated using local healthcare authority costs of residential care.

Results 2,378 stroke patients were included. The mean age was 73.6 (SD 14.1), 50.0 % were male, and the median NIHSS was 3 (IQR 1-7). 754 patients had one comorbidity (31.7%), and 763 patients had 2 or more (32.09%). Those with multimorbidity incurred higher costs of institutionalisation ($50,807 95%CI $41,301 - $60,805) compared to those without comorbidity ($40,739 95%CI $30,993 - $50,838; p<0.001). Multimorbidity was predictive of institutionalisation (crude HR 1.79, 95%CI 1.30-2.46), as well as after adjustment for stroke severity (aHR 1.67, 95%CI 1.21-2.30), but was attenuated following further adjustment for age and sex (aHR 1.21, 95%CI 0.88-1.66). Dementia was the sole individual comorbidity to predict institutionalisation after adjustment for age, sex, and stroke severity (aHR 2.78, 95%CI 1.90 - 4.08).

Conclusions As expected, prior dementia independently predicted institutionalisation following stroke, but prior multimorbidity did not.

Authors/Disclosures
Matthew Downer (Wolson Centre for the Prevention of Stroke and Dementia) PRESENTER	Mr. Downer has received research support from Canadian Institutes of Health Research (DFD - 175796) and Rhodes Trust for his PhD studies.
	No disclosure on file
Linxin Li, MD	The institution of Dr. Li has received research support from Medical Research Foundation.
	No disclosure on file

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