An increased risk of stroke among young schizophrenia patients Herng-Ching Lin a , Fei-Hsiu Hsiao b , Stefani Pfeiffer c , Yi-Ting Hwang d , Hsin-Chien Lee e,f, ⁎ a School of Health Care Administration, Taipei Medical University, 250 Wu-Hsing St., Taipei 110, Taiwan b Taipei Medical University, College of Nursing, Taipei, Taiwan c Department of History, Rutgers University, New Jersey, USA d National Taipei University, Department of Statistics, Taipei, Taiwan e Taipei Medical University Hospital, Department of Psychiatry, Taipei, Taiwan f Taipei Medical University, School of Medicine, Department of Psychiatry, Taipei, Taiwan Received 23 October 2007; received in revised form 30 November 2007; accepted 23 December 2007 Available online 8 February 2008 Abstract Objective: This study sets out to estimate the risk of stroke developing among young schizophrenia patients during a five-year follow-up period after hospitalization for episodes of acute exacerbation. Methods: Hospitalized schizophrenia patients under 45 years of age were identified from the Taiwan National Health Insurance Research Database for the year 1998 (n =5001). Two age-matched cases were randomly selected for each schizophrenia patient from among patients who underwent appendectomies in the same year (n = 10,002). Each individual patient was retrospectively followed up from 1998 until the end of 2003 to determine whether any had developed strokes. Cox proportional hazard regressions were carried out to compute the adjusted five-year survival rate. Results: A total of 219 patients (1.46%) developed strokes during the five-year follow-up period, with the attacks occurring among 2.46% of schizophrenia patients and 0.94% of the comparison cohort. Following adjustment for patients' demographic characteristics, select comorbid medical disorders and substance abuse, schizophrenia patients were found to be 2.02 times ( p b 0.001) more likely to develop strokes during the follow-up period than age-matched appendectomy patients. The adjusted hazard ratios of developing stroke for male and female schizophrenia patients were, respectively, 1.64 ( p b 0.001) and 2.87 ( p b 0.001) times greater than their counterparts in the comparison group. Conclusions: As compared with the comparison group, young schizophrenia patients demonstrated a two-fold increased risk of developing stroke during the five-year period after hospitalization. The risk of developing stroke among schizophrenia patients was found to be much higher for females than males. © 2008 Elsevier B.V. All rights reserved. Keywords: Schizophrenia; Stroke; Young stroke 1. Introduction Higher medical morbidity and mortality rates have been reported in a number of studies on schizophrenia patients (Brown, 1997; Osby et al., 2000; Brown et al., Available online at www.sciencedirect.com Schizophrenia Research 101 (2008) 234 – 241 www.elsevier.com/locate/schres ⁎ Corresponding author. Department of Psychiatry, Taipei Medical University & Hospital, 252 Wu-Hsing St., Taipei, 110, Taiwan. Tel.: +886 2 2737 2181x3667; fax: +886 2 2378 9788. E-mail address: ellalee@tmu.edu.tw (H.-C. Lee). 0920-9964/$ - see front matter © 2008 Elsevier B.V. All rights reserved. doi:10.1016/j.schres.2007.12.485