TY - JOUR
T1 - Substance Use and Performance of Toxicology Screens in the Greater Cincinnati Northern Kentucky Stroke Study
AU - Madsen, Tracy E.
AU - Cummings, Olivia W.
AU - De Los Rios La Rosa, Felipe
AU - Khoury, Jane C.
AU - Alwell, Kathleen
AU - Woo, Daniel
AU - Ferioli, Simona
AU - Martini, Sharyl
AU - Adeoye, Opeolu
AU - Khatri, Pooja
AU - Flaherty, Matthew L.
AU - Mackey, Jason
AU - Mistry, Eva A.
AU - Demel, Stacie L.
AU - Coleman, Elisheva
AU - Jasne, Adam S.
AU - Slavin, Sabreena J.
AU - Walsh, Kyle
AU - Star, Michael
AU - Broderick, Joseph P.
AU - Kissela, Brett M.
AU - Kleindorfer, Dawn O.
N1 - Funding Information:
Dr Khoury, K. Alwell, Dr Woo, Dr Ferioli, Dr Khatri, Dr Flaherty, Dr Mackey, E.A. Mistry, Dr Slavin, Dr Kissela, and Dr Kleindorfer are supported by a research grant (NINDS R01NS30678). Dr De Los Rios La Rosa reports employment by Baptist Health South Florida and compensation from AstraZeneca for other services. Dr Adeoye reports service as Chief Medical Officer for sense diagnostics and compensation from NICO Corporation for data and safety monitoring services. Dr Flaherty reports compensation from CSL Behring for other services and compensation from Alexion Pharmaceuticals for other services. Dr Demel reports compensation from Genentech for other services. Dr Walsh reports grants from Jan Medical, Inc, grants from Sense Diagnostics LLC, and grants from the American Heart Association. Dr Kissela reports service as Board of Directors, Member for American Academy of Neurology, and employment by University of Cincinnati. The other authors report no conflicts.
Funding Information:
GCNKSS (Greater Cincinnati Northern Kentucky Stroke Study) was funded by a grant from the National Institutes of Neurological Disorders and Stroke (R01 NS 30678). Dr Madsen is funded by the National Heart, Lung, and Blood Institute (K23 HL140081).
Publisher Copyright:
© 2022 Lippincott Williams and Wilkins. All rights reserved.
PY - 2022/10/1
Y1 - 2022/10/1
N2 - Background: Though stroke risk factors such as substance use may vary with age, less is known about trends in substance use over time or about performance of toxicology screens in young adults with stroke. Methods: Using the Greater Cincinnati Northern Kentucky Stroke Study, a population-based study in a 5-county region comprising 1.3 million people, we reported the frequency of documented substance use (cocaine/marijuana/opiates/other) obtained from electronic medical record review, overall and by race/gender subgroups among physician-adjudicated stroke events (ischemic and hemorrhagic) in adults 20 to 54 years of age. Secondary analyses included heavy alcohol use and cigarette smoking. Data were reported for 5 one-year periods spanning 22 years (1993/1994-2015), and trends over time were tested. For 2015, to evaluate factors associated with performance of toxicology screens, multiple logistic regression was performed. Results: Overall, 2152 strokes were included: 74.5% were ischemic, mean age was 45.7±7.6, 50.0% were women, and 35.9% were Black. Substance use was documented in 4.4%, 10.4%, 19.2%, 24.0%, and 28.8% of cases in 1993/1994, 1999, 2005, 2010, and 2015, respectively (Ptrend<0.001). Between 1993/1994 and 2015, documented substance use increased in all demographic subgroups. Adjusting for gender, comorbidities, and National Institutes of Health Stroke Scale, predictors of toxicology screens included Black race (adjusted odds ratio, 1.58 [95% CI, 1.02-2.45]), younger age (adjusted odds ratio, 0.70 [95% CI, 0.53-0.91], per 10 years), current smoking (adjusted odds ratio, 1.62 [95% CI, 1.06-2.46]), and treatment at an academic hospital (adjusted odds ratio, 1.80 [95% CI, 1.14-2.84]). After adding chart-reported substance use to the model, only chart-reported substance abuse and age were significant. Conclusions: In a population-based study of young adults with stroke, documented substance use increased over time, and documentation of substance use was higher among Black compared with White individuals. Further work is needed to confirm race-based disparities and trends in substance use given the potential for bias in screening and documentation. Findings suggest a need for more standardized toxicology screening.
AB - Background: Though stroke risk factors such as substance use may vary with age, less is known about trends in substance use over time or about performance of toxicology screens in young adults with stroke. Methods: Using the Greater Cincinnati Northern Kentucky Stroke Study, a population-based study in a 5-county region comprising 1.3 million people, we reported the frequency of documented substance use (cocaine/marijuana/opiates/other) obtained from electronic medical record review, overall and by race/gender subgroups among physician-adjudicated stroke events (ischemic and hemorrhagic) in adults 20 to 54 years of age. Secondary analyses included heavy alcohol use and cigarette smoking. Data were reported for 5 one-year periods spanning 22 years (1993/1994-2015), and trends over time were tested. For 2015, to evaluate factors associated with performance of toxicology screens, multiple logistic regression was performed. Results: Overall, 2152 strokes were included: 74.5% were ischemic, mean age was 45.7±7.6, 50.0% were women, and 35.9% were Black. Substance use was documented in 4.4%, 10.4%, 19.2%, 24.0%, and 28.8% of cases in 1993/1994, 1999, 2005, 2010, and 2015, respectively (Ptrend<0.001). Between 1993/1994 and 2015, documented substance use increased in all demographic subgroups. Adjusting for gender, comorbidities, and National Institutes of Health Stroke Scale, predictors of toxicology screens included Black race (adjusted odds ratio, 1.58 [95% CI, 1.02-2.45]), younger age (adjusted odds ratio, 0.70 [95% CI, 0.53-0.91], per 10 years), current smoking (adjusted odds ratio, 1.62 [95% CI, 1.06-2.46]), and treatment at an academic hospital (adjusted odds ratio, 1.80 [95% CI, 1.14-2.84]). After adding chart-reported substance use to the model, only chart-reported substance abuse and age were significant. Conclusions: In a population-based study of young adults with stroke, documented substance use increased over time, and documentation of substance use was higher among Black compared with White individuals. Further work is needed to confirm race-based disparities and trends in substance use given the potential for bias in screening and documentation. Findings suggest a need for more standardized toxicology screening.
KW - documentation
KW - racial groups
KW - risk factors
KW - stroke
KW - substance-related disorders
UR - http://www.scopus.com/inward/record.url?scp=85139285703&partnerID=8YFLogxK
U2 - 10.1161/STROKEAHA.121.038311
DO - 10.1161/STROKEAHA.121.038311
M3 - Article
C2 - 35862206
AN - SCOPUS:85139285703
SN - 0039-2499
VL - 53
SP - 3082
EP - 3090
JO - Stroke
JF - Stroke
IS - 10
ER -