Socioeconomic status does not predict cocaine use among ischemic stroke patients: A nested case-control study

Previous studies of cocaine use and stroke have focused on acute effects of cocaine in perceived high-risk populations. We characterized mechanisms and risk factors for cocaine use among ischemic stroke patients from a broad range of socioeconomic backgrounds to inform medical management decisions and prevention efforts. We studied consecutive adults admitted with acute ischemic stroke to our institution between January 2007 and December 2010 with a history or laboratory confirmation of cocaine use. Age, sex, and race-matched cocaine-negative controls were derived from the same study population. Demographics, risk factors, clinical and imaging data were compared between groups. Among 4073 acute ischemic stroke patients, 91 (2.2%) had a history of cocaine use and/or a positive toxicology screen (cases). Cocaine abusers did not differ from controls by occupation, income, or educational level (P > 0.5). Active tobacco use independently increased the odds of cocaine use among stroke patients (odds ratio 3.9, 95% confidence interval 2.0-7.5), as did the history of migraine (odds ratio 2.5, 95% confidence interval 1.1-5.9). Stroke subtype also predicted cocaine use among stroke patients (odds ratio 0.73, 95% confidence interval 0.58-0.93). Stroke patients with current or past cocaine use could not be distinguished from non-users by socioeconomic factors. Liberal use of toxicology screening among a much broader population of patients is needed for proper identification and management. Further study of causal mechanisms for cardioembolism in cocaine-associated stroke is warranted.