Date of Award


Document Type


Degree Name

Doctor of Philosophy (PhD)


College of Health Professions

First Advisor

Heather S. Bonilha

Second Advisor

Kit N. Simpson

Third Advisor

Annie N. Simpson

Fourth Advisor

Leonardo F. Bonilha


Background: Post-stroke dysphagia and post-stroke depression (PSD) can have devastating effects on stroke survivors and substantial financial impacts on the healthcare system; however, there is a dearth of research examining this patient population. Thus, we studied the incidence, risk, and cost of PSD in patients with post-stroke dysphagia. Methods: We conducted a retrospective, cross-sectional study of individuals with a primary diagnosis of acute ischemic stroke and secondary diagnoses of dysphagia and/or depression using administrative claims data from the 2017 Medicare 5% Limited Data Set. Additionally, we developed a novel dysphagia severity index for use with administrative data and applied it to our data sets. Results: Persons with post-stroke dysphagia were as, or slightly more, likely to have PSD compared to the general stroke population. Those with dysphagia (irrespective of severity) had greater odds and hazard of diagnosis of PSD in the 90 days after discharge, and those with dysphagia and PSD incurred higher healthcare costs. Conclusion: Our results supported an association between post-stroke dysphagia and PSD and that the presence of PSD in patients with post-stroke dysphagia increased post-discharge cost. Thus, future research is warranted to further explore the effects of PSD on post-stroke dysphagia.


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