Long-term causes of death in 888,003 ischemic stroke patients in Thailand: a nationwide retrospective study with 18-year follow-up

BACKGROUND: Ischemic stroke (IS) remains a major cause of mortality and disability worldwide, although the causes of death after stroke have changed. Long-term mortality data from low- and middle-income countries are limited. We investigated the fatality rates and causes of death in patients with IS in Thailand within and beyond 30 days post-discharge. METHODS: We conducted a retrospective descriptive study using national hospital database records from 2004-2022. Patients with IS (ICD-10 code I63) were included without age or sex restrictions, with death status followed through 2022. The causes of death included stroke, complications, comorbidities, accidents, suicide, and unknown causes. Mortality was analyzed during hospitalization and ≤30 and >30 days post-discharge. RESULTS: Among 888,003 patients with IS, the overall mortality was 47.6%: in-hospital 6.4%; ≤30 days post-discharge 8.2%; and >30 days post-discharge 33.1%. Mortality rates increased notably with age, exceeding 80% in those aged > 85 years. Stroke caused most in-hospital (58.6%) and short-term deaths (29.1%), whereas long-term mortality was primarily due to complications (30.7%) and comorbidities (30.5%). The leading comorbid causes were heart disease, dementia, and neoplasm; while pneumonia and sepsis were the primary fatal complications. Age-related debility, COVID-19 infection, and cardiovascular collapse were other major causes. CONCLUSION: This nationwide study revealed dynamic changes in post-IS causes, with stroke predominating early deaths, while complications and comorbidities determined long-term outcomes. These findings highlight the need for integrated acute and post-discharge stroke care strategies targeting infection prevention, comorbidity management, and elder care.