Person: Munoz Venturelli, Paula
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Munoz Venturelli
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Paula
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Publication Sex Differences in Profile and In-Hospital Death for Acute Stroke in Chile: Data From a Nationwide Hospital Registry(2024) Nuñez, Marilaura; Allende, María; González, Francisca; Cavada, Gabriel; Anderson, Craig; Munoz Venturelli, PaulaBackground: Knowledge of local contextual sex differences in the profile and outcome for stroke can improve service delivery. We aimed to determine sex differences in the profile of patients with acute stroke and their associations with in-hospital death in the national hospital database of Chile. Methods and results: We present a retrospective cohort based on the analysis of the 2019 Chilean database of Diagnosis-Related Groups, which represents 70% of the operational expenditure of the public health system. Random-effects multiple logistic regression models were used to determine independent associations of acute stroke (defined by main diagnosis International Classification of Diseases, Tenth Revision [ICD-10] codes) and in-hospital death, and reported with odds ratios (ORs) and 95% CIs. Of 1 048 575 hospital discharges, 15 535 were for patients with acute stroke (7074 [45.5%] in women), and 2438 (15.6%) of them died during hospitalization. Differences by sex in sociodemographic and clinical characteristics were identified for stroke and main subtypes. After fully adjusted model, women with ischemic stroke had lower in-hospital death (OR, 0.79 [95% CI, 0.69-0.91]) compared with men; other independent predictors included age per year increase (OR, 1.03 [95% CI, 1.03-1.04]), chronic kidney disease (OR, 1.47 [95% CI, 1.20-1.80]), atrial fibrillation (OR, 1.50 [95% CI, 1.26-1.80]), and other risk factors. Conversely, for intracerebral hemorrhage, women had a higher in-hospital mortality rate than men (OR, 1.19 [95% CI, 1.02-1.40]); other independent predictors included age per year increase (OR, 1.009 [95% CI, 1.003-1.01]), chronic kidney disease (OR, 1.55 [95% CI, 1.23-1.97]), oral anticoagulant use (OR, 1.88 [95% CI, 1.37-2.58]), and other risk factors. Conclusions: Sex differences in characteristics and in-hospital death of hospitalized patients exist for acute stroke in Chile. In-hospital death is higher for acute ischemic stroke in men and higher for intracerebral hemorrhage in women. Future research is needed to better identify contributing factors.Publication Multimorbidity in acute ischemic stroke and its impact on short-term mortality: A Chilean nationwide database analysis(2025) González, Francisca; Allende, María; Nuñez, Marilaura; Delgado, Iris; Jakszyn, Paula; Delfino, Carlos; Anderson, Craig; Munoz Venturelli, PaulaBackground: Multimorbidity predicts a worse prognosis for various diseases but its impact in people after an acute ischemic stroke (AIS) in developing societies is not well established. We aimed to characterize the pattern of multimorbidity and determine its association with in-hospital mortality after AIS in the nationwide Chilean database. Methods: A retrospective analysis of the Diagnosis-Related Groups database for hospitalized adult patients in Chile in 2019 was conducted. Association of multimorbidity, defined as the presence of ≥2 health conditions, in patients with AIS (ICD-10 code I63) on in-hospital mortality was determined in logistic regression models adjusted for confounding variables. Results: Of 1,048,575 recorded ICD-10 codes, there were 10,440 AIS episodes in whom 7,696 (73.7 %) patients had multimorbidity. Age, female sex, and low socioeconomic status were associated with a higher multimorbidity, and the combination of comorbidities differed across age groups. Cardiometabolic multimorbidity was associated with higher in-hospital mortality (odds ratio [OR] 1.39, 95 % confidence interval [CI] 1.16-1.66; p<0.001). Stage 5 chronic kidney disease combined with ischemic heart disease was the comorbidity with the highest risk of death (OR 4.20, 95 %CI 1.58-11.16; p = 0.004). Obesity, which exhibited a predominance in early to mid-life, had the highest association with mortality when combined with other conditions. Conclusions: Multimorbidity is common in patients with AIS and its components vary by age and sex. Cardiometabolic multimorbidity increases the likelihood of in-hospital mortality. Adopting a multimorbidity-focused approach to stroke care could improve outcomes.