The risk of stroke and post-stroke mortality in people with schizophrenia: A systematic review and meta-analysis study

Abstract

<p>Sources of heterogeneity in risk of stroke and mortality risk following acute-stroke in <a href="https://www.sciencedirect.com/topics/neuroscience/dementia-praecox" title="Learn more about schizophrenia from ScienceDirect's AI-generated Topic Pages">schizophrenia</a> are understudied. We systematically searched four electronic-databases until 1-November-2022, and conducted meta-analysis to synthesize estimates of stroke-risk and post-stroke mortality for schizophrenia patients relative to non-schizophrenia counterparts. Subgroup-analyses and meta-regression models stratified by sex, nature of sample (incident/prevalent), geographical region, study-period and time-frame following stroke were conducted when applicable. Fifteen and 5 studies were included for meta-analysis of stroke-risk (<em>n</em>=18,368,253; 129,095 schizophrenia patients) and all-cause post-stroke mortality (<em>n</em>=289,231; 4,477 schizophrenia patients), respectively. Schizophrenia patients exhibited elevated stroke-risk (relative-risk =1.55[95% CI:1.31–1.84]) relative to non-schizophrenia controls. Schizophrenia was associated with increased stroke-risk in both sexes, study-periods of 1990s and 2000s, and irrespective of nature of sample and geographical regions. Meta-regression revealed regional differences in relative-risk for stroke, but limited by small number of studies. After removal of an outlier study, meta-analysis demonstrated that schizophrenia was associated with increased overall (hazard-ratio=1.37[1.30–1.44]), short-term (≤90 days; 1.29[1.14–1.46]) and longer-term (≥1 year; 1.45[1.32–1.60]) post-stroke mortality rates. Raised post-stroke mortality rate for schizophrenia was observed irrespective of nature of sample, geographical regions and study-periods. Taken together, schizophrenia is associated with increased stroke-risk and post-stroke mortality. Multilevel-interventions are required to reduce these physical-health disparities.<br></p>