Abstract Details

Ischemic stroke risk is elevated with SCI/D based on data from Taiwan [Wu et al, Neurology. 2012;78:1051–1057].  Whether SCI/D increases ischemic stroke risk in US Veterans has been unconfirmed.

We evaluated whether spinal cord injuries and disorders (SCI/D) are a risk factor for ischemic stroke in US Veterans.

Using a retrospective dual-cohort design, adjusted stroke incidence was estimated for Veterans with and without SCI/D between fiscal years 2017-2021 using Veterans Health Administration (VHA) and Medicare utilization data. Veterans with ischemic stroke were identified using ICD-10 codes for cerebral infarction or sequalae of cerebral infarction. Veterans with prior diagnoses of ischemic stroke or sequelae were excluded. Incidence rate ratios were estimated using Poisson regression models adjusted for Veteran characteristics including common stroke risk factors, and prescriptions for stroke-prophylactic medications (antiplatelet agents, antilipid agents, and anticoagulants) immediately preceding the retrospective observation period.

Analyses included 560,314 Veterans. Adjusting for person-days in the 5-year period, 7.2% with SCI/D vs 5.7% without had a stroke [p < .001], reflecting an incidence rate ratio (IRR) of 1.27 [95%CI: 1.19 – 1.36].  Adjusting for age, sex, smoking, diabetes, hypertension, atrial fibrillation, race and ethnicity yielded a 26% higher stroke incidence with SCI/D than without [IRR 1.26, 95%CI: 1.17 – 1.35]. Further adjusting for stroke-prophylactic prescriptions yielded a 19% higher stroke incidence with SCI/D than without [IRR 1.19, 95%CI: 1.11-1.27]. Compared to controls, stroke incidence was 50% and 31% higher with high and low tetraplegia, respectively [IRR 1.50, 95%CI: 1.16 – 1.92 and IRR 1.31, 95%CI: 1.02 – 1.67]. Stroke incidence was 36% higher with non-traumatic SCI/D [IRR 1.36, 95%CI: 1.24-1.49], whereas stroke incidence with traumatic SCI was not significantly higher than controls [IRR 1.05, 95%CI: 0.95-1.17]. 

SCI/D is a risk factor for ischemic stroke in US Veterans, especially for Veterans with tetraplegia and non-traumatic injuries.