Disparities in Treatment and Discharge Outcomes Among Cannabis Users in Ischemic Stroke Hospitalizations
Neel Patel1, Urvish Patel2, San Kim3, Aakriti Dhiman4, Sanjana Prakash5, Vipul Rakhunde6, Maheshbabu Tatineni7, Goranti Jyothsna8, Lokesh Patil9, Greshaben Patel10, Prasannakumar Gajera11, Ravi Soni12, Nils Hennig1, Shamik Shah13
1Icahn School of Medicine at Mount Sinai, 2Icahn School of Medicine At Mount Sinai/ Creighton University, 3Korea house, 4B J Medical College and Civil Hospital, 5JJM Medical College, 6Signature Hospital, 7P.S.I Medical College, 8Bhaskara Medical College, 9Stony Brook Medicine, 10B J Medical College, 11Tower Health - Reading Hospital, 12Reading Hospital Tower health, 13Stormont Vail Health, NeuroHospitalist Program
Objective:
To assess the treatment disparities and their impact on discharge outcomes among cannabis users experiencing ischemic stroke hospitalizations.
Background:
Stroke is becoming more common in young adults and is the eighth leading cause of death in people aged 25 to 45 in the United States. Drug use is one of the most common modifiable risk factors for stroke in this age group. Although tobacco use and cocaine use are known risk factors for ischemic stroke, the role of cannabis use and its effect on stroke outcome is unknown. We hypothesized that ischemic stroke hospitalizations among cannabis users would be associated with intensive treatment and poor discharge outcomes.
Design/Methods:
We performed a population-based retrospective analysis of the Nationwide Inpatient Sample (years 2000-2017) in acute ischemic stroke adult hospitalizations to compare the treatment utilization and outcomes in cannabis users (dependent and non-dependent abuse) using ICD-9 and 10-CM codes. We evaluated discharge disposition as home vs non-home (transfer to a short-term hospital stay, skilled nursing facility(SNF), and home health care(HHC)). Weighted analyses using a chi-square test and multivariable survey logistic regression were used to evaluate the discharge outcomes.
Results:
Amongst the total of 5,690,773 AIS hospitalizations, 50,895 (0.89%) cannabis users were identified from 2003 to 2017. Compared to non-cannabis, cannabis users had higher rate of mechanical thrombectomy and recombinant tissue plasminogen activator utilization (0.61% vs 0.27%) and (3.79% vs 2.81%), [p<0.0001], respectively. Study revealed that cannabis users had higher odds of transfer to a short-term hospital stay, SNF, and HHC after mechanical thrombectomy (OR 2.25, 95%CI 1.41-3.58) and rt-PA utilization (OR 1.29, 95%CI 1.09-1.53), [p<0.0001].
Conclusions:
Our findings indicate poor discharge outcomes among cannabis users in ischemic stroke hospitalizations, necessitating robust post-stroke treatment. Safety concerns regarding cannabinoid use in neurovascular insults warrant further longitudinal studies to delineate risks and benefits in stroke patients.