{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T16:01:43Z","timestamp":1791475303899,"version":"4.3.4"},"reference-count":31,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"14","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2021,7,20]]},"abstract":"<jats:sec xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">The incidence of ischemic stroke has increased among adults aged 18 to 64\u00a0years, yet little is known about relationships between specific risk factors and outcomes. This study investigates in\u2010hospital and long\u2010term outcomes in patients with stroke aged &lt;65\u00a0years with preexisting diabetes mellitus.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods and Results<\/jats:title>\n            <jats:p xml:lang=\"en\">Consecutive patients aged &lt;65\u00a0years admitted to comprehensive stroke centers for acute ischemic stroke between 2003 and 2013 were identified from the Ontario Stroke Registry. Multinomial logistic regression was used to estimate adjusted odds ratio (OR [95% CI]) of in\u2010hospital mortality or direct discharge to long\u2010term or continuing care. Cox proportional hazards regression was used to estimate the adjusted hazards ratio (aHR [95% CI]) of long\u2010term mortality, readmission for stroke\/transient ischemic attack, admission to long\u2010term care, and incident dementia. Predefined sensitivity analyses examined stroke outcomes among young (aged 18\u201349\u00a0years) and midlife (aged 50\u201365\u00a0years) subgroups. Among 8293 stroke survivors (mean age, 53.6\u00b18.9\u00a0years), preexisting diabetes mellitus was associated with a higher likelihood of in\u2010hospital death (adjusted OR, 1.46 [95% CI, 1.14\u20131.87]) or direct discharge to long\u2010term care (adjusted OR, 1.65 [95% CI, 1.07\u20132.54]). Among stroke survivors discharged (N=7847) and followed up over a median of 6.3\u00a0years, preexisting diabetes mellitus was associated with increased hazards of death (aHR, 1.68 [95% CI, 1.50\u20131.88]), admission to long\u2010term care (aHR, 1.57 [95% CI, 1.35\u20131.82]), readmission for stroke\/transient ischemic attack (aHR, 1.37 [95% CI, 0.21\u20131.54]), and incident dementia (aHR, 1.44 [95% CI, 1.17\u20131.77]). Only incident dementia was not increased for young stroke survivors.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">Focused secondary prevention and risk factor management may be needed to address poor long\u2010term outcomes for patients with stroke aged &lt;65 years with preexisting diabetes mellitus.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.120.019991","type":"journal-article","created":{"date-parts":[[2021,7,3]],"date-time":"2021-07-03T13:07:53Z","timestamp":1625317673000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":16,"title":["Diabetes Mellitus Is Associated With Poor In\u2010Hospital and Long\u2010Term Outcomes in Young and Midlife Stroke Survivors"],"prefix":"10.1161","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7300-2355","authenticated-orcid":false,"given":"Bradley J.","family":"MacIntosh","sequence":"first","affiliation":[{"name":"Hurvitz Brain Sciences ProgramSunnybrook Research Institute Toronto ON Canada"},{"name":"Heart and Stroke Foundation Canadian Partnership for Stroke Recovery Toronto ON Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ellen","family":"Cohen","sequence":"additional","affiliation":[{"name":"Heart and Stroke Foundation Canadian Partnership for Stroke Recovery Toronto ON Canada"},{"name":"Department of Physical Therapy University of Toronto Toronto ON Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica","family":"Colby\u2010Milley","sequence":"additional","affiliation":[{"name":"Hurvitz Brain Sciences ProgramSunnybrook Research Institute Toronto ON Canada"},{"name":"Heart and Stroke Foundation Canadian Partnership for Stroke Recovery Toronto ON Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiming","family":"Fang","sequence":"additional","affiliation":[{"name":"ICES Toronto ON Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Limei","family":"Zhou","sequence":"additional","affiliation":[{"name":"ICES Toronto ON Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Ouk","sequence":"additional","affiliation":[{"name":"Hurvitz Brain Sciences ProgramSunnybrook Research Institute Toronto ON Canada"},{"name":"Department of Pharmacology &amp; 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