The Mortality and the Risk of Aspiration Pneumonia Related with Dysphagia in Stroke Patients Ming-Chu Feng, MS,* , † Yi-Ching Lin, MD, PhD,‡ , § , jj Yu-Han Chang, MS,{ Chun-Hung Chen, MD, PhD,# Hsiu-Chu Chiang, MS,** Ling-Chun Huang, MD,†† , ‡‡ Yuan-Han Yang, MD, PhD,†† , ‡‡ , §§ and Chih-Hsing Hung, MD, PhDjj , jjjj , {{ , ## , *** Background: Dysphagia may result in poor outcomes in stroke patients due to aspira- tion pneumonia and malnutrition. Goal: The aim of the study was to investigate aspira- tion pneumonia and the mortality rate in stroke patients with dysphagia in Taiwan. Methods: We selected 1220 stroke patients, divided them into dysphagia and nondy- sphagia groups, and matched them according to age; covariates and comediations from 2000 to 2005 were identified from the NHIRD 2000 database. The date of the diag- nosed stroke for each patient was defined as the index date. All patients were tracked for 5 years following their index visit to evaluate mortality and the risk of aspiration pneumonia. We estimated the adjusted hazard ratio using Cox proportional hazard regression. Results: Within 1 year, the dysphagia group was 4.69 times more likely to develop aspiration pneumonia than the nondysphagia group (adjusted hazard ratio [aHR], 4.69; 95% confidence interval [CI] 2.83-7.77; P < .001). The highest significant risk of aspiration pneumonia was in the cerebral hemorrhage patients within 3 years of the index visit (aHR, 5.04; 95% CI 1.45-17.49; P = .011). The 5-year mortality rate in the dysphagia group was significantly higher than that in the nondysphagia group (aHR, 1.84; 95% CI 1.57-2.16; P < .001). Conclusion: Dysphagia is a critical factor in aspiration pneumonia and mortality in stroke patients. Early detection and intervention of dys- phagia in stroke patients may reduce the possibility of aspiration pneumonia. Key Words: Aspiration pneumonia—survival rate—stroke—dysphagia © 2019 Elsevier Inc. All rights reserved. From the *Department of Nursing, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan; †School of Nursing, Fooyin University, Kaoh- siung, Taiwan; ‡Department of Laboratory Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; §Department of Laboratory Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; jjDepartment of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; {Teaching and Research Center of Kaohsiung Municipal Siaogang Hospital, Kaohsiung, Taiwan; # Department of Neurology, Kaohsiung Municipal Siaogang Hospital, Kaohsiung, Taiwan; **Department of Nursing, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; ††Department of Neurology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan; ‡‡Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung Taiwan; §§Department of Master’s Program in Neurology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; jjjjDepartment of Pediatrics, Faculty of Pediatrics, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; {{Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; ## Department of Pediatrics, Kaohsiung Municipal Siaogang Hospital, Kaohsiung, Taiwan; and ***Research Center for Environmental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan. Received November 5, 2018; revision received January 7, 2019; accepted February 11, 2019. Grant support: This study was supported by Kaohsiung Municipal Ta-Tung Hospital Research Foundation (kmtth-107-010). Address Correspondence to Chih-Hsing Hung, MD, PhD, Department of Pediatrics, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan. E-mail: pedhung@gmail.com. 1052-3057/$ - see front matter © 2019 Elsevier Inc. All rights reserved. https://doi.org/10.1016/j.jstrokecerebrovasdis.2019.02.011 Journal of Stroke and Cerebrovascular Diseases, Vol. &&, No. && (&&), 2019: &&&& 1 ARTICLE IN PRESS