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Risk factors for subarachnoid haemorrhage : a nationwide cohort of 950 000 adults

Sundström, Johan ; Söderholm, Martin LU ; Söderberg, Stefan ; Alfredsson, Lars ; Andersson, Martin ; Bellocco, Rino ; Björck, Martin ; Broberg, Per LU ; Eriksson, Maria and Eriksson, Marie , et al. (2019) In International Journal of Epidemiology 48(6). p.2018-2025
Abstract

BACKGROUND: Subarachnoid haemorrhage (SAH) is a devastating disease, with high mortality rate and substantial disability among survivors. Its causes are poorly understood. We aimed to investigate risk factors for SAH using a novel nationwide cohort consortium. METHODS: We obtained individual participant data of 949 683 persons (330 334 women) between 25 and 90 years old, with no history of SAH at baseline, from 21 population-based cohorts. Outcomes were obtained from the Swedish Patient and Causes of Death Registries. RESULTS: During 13 704 959 person-years of follow-up, 2659 cases of first-ever fatal or non-fatal SAH occurred, with an age-standardized incidence rate of 9.0 [95% confidence interval (CI) (7.4-10.6)/100 000 person-years]... (More)

BACKGROUND: Subarachnoid haemorrhage (SAH) is a devastating disease, with high mortality rate and substantial disability among survivors. Its causes are poorly understood. We aimed to investigate risk factors for SAH using a novel nationwide cohort consortium. METHODS: We obtained individual participant data of 949 683 persons (330 334 women) between 25 and 90 years old, with no history of SAH at baseline, from 21 population-based cohorts. Outcomes were obtained from the Swedish Patient and Causes of Death Registries. RESULTS: During 13 704 959 person-years of follow-up, 2659 cases of first-ever fatal or non-fatal SAH occurred, with an age-standardized incidence rate of 9.0 [95% confidence interval (CI) (7.4-10.6)/100 000 person-years] in men and 13.8 [(11.4-16.2)/100 000 person-years] in women. The incidence rate increased exponentially with higher age. In multivariable-adjusted Poisson models, marked sex interactions for current smoking and body mass index (BMI) were observed. Current smoking conferred a rate ratio (RR) of 2.24 (95% CI 1.95-2.57) in women and 1.62 (1.47-1.79) in men. One standard deviation higher BMI was associated with an RR of 0.86 (0.81-0.92) in women and 1.02 (0.96-1.08) in men. Higher blood pressure and lower education level were also associated with higher risk of SAH. CONCLUSIONS: The risk of SAH is 45% higher in women than in men, with substantial sex differences in risk factor strengths. In particular, a markedly stronger adverse effect of smoking in women may motivate targeted public health initiatives.

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published
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keywords
cohort study, epidemiology, Stroke
in
International Journal of Epidemiology
volume
48
issue
6
pages
8 pages
publisher
Oxford University Press
external identifiers
  • pmid:31363756
  • scopus:85077223111
ISSN
1464-3685
DOI
10.1093/ije/dyz163
language
English
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yes
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f136e2ca-3618-432e-8a75-37d9c1dc3cb2
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2020-01-10 14:33:04
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2020-01-28 15:06:11
@article{f136e2ca-3618-432e-8a75-37d9c1dc3cb2,
  abstract     = {<p>BACKGROUND: Subarachnoid haemorrhage (SAH) is a devastating disease, with high mortality rate and substantial disability among survivors. Its causes are poorly understood. We aimed to investigate risk factors for SAH using a novel nationwide cohort consortium. METHODS: We obtained individual participant data of 949 683 persons (330 334 women) between 25 and 90 years old, with no history of SAH at baseline, from 21 population-based cohorts. Outcomes were obtained from the Swedish Patient and Causes of Death Registries. RESULTS: During 13 704 959 person-years of follow-up, 2659 cases of first-ever fatal or non-fatal SAH occurred, with an age-standardized incidence rate of 9.0 [95% confidence interval (CI) (7.4-10.6)/100 000 person-years] in men and 13.8 [(11.4-16.2)/100 000 person-years] in women. The incidence rate increased exponentially with higher age. In multivariable-adjusted Poisson models, marked sex interactions for current smoking and body mass index (BMI) were observed. Current smoking conferred a rate ratio (RR) of 2.24 (95% CI 1.95-2.57) in women and 1.62 (1.47-1.79) in men. One standard deviation higher BMI was associated with an RR of 0.86 (0.81-0.92) in women and 1.02 (0.96-1.08) in men. Higher blood pressure and lower education level were also associated with higher risk of SAH. CONCLUSIONS: The risk of SAH is 45% higher in women than in men, with substantial sex differences in risk factor strengths. In particular, a markedly stronger adverse effect of smoking in women may motivate targeted public health initiatives.</p>},
  author       = {Sundström, Johan and Söderholm, Martin and Söderberg, Stefan and Alfredsson, Lars and Andersson, Martin and Bellocco, Rino and Björck, Martin and Broberg, Per and Eriksson, Maria and Eriksson, Marie and Forsberg, Bertil and Fransson, Eleonor I. and Giedraitis, Vilmantas and Theorell-Haglöw, Jenny and Hallqvist, Johan and Hansson, Per Olof and Heller, Susanne and Håkansson, Niclas and Ingelsson, Martin and Janson, Christer and Järvholm, Bengt and Khalili, Payam and Knutsson, Anders and Lager, Anton and Lagerros, Ylva Trolle and Larsson, Susanna C. and Leander, Karin and Leppert, Jerzy and Lind, Lars and Lindberg, Eva and Magnusson, Cecilia and Magnusson, Patrik K.E. and Malfert, Mauricio and Michaëlsson, Karl and Nilsson, Peter and Olsson, Håkan and Pedersen, Nancy L. and Pennlert, Johanna and Rosenblad, Andreas and Rosengren, Annika and Torén, Kjell and Wanhainen, Anders and Wolk, Alicja and Engström, Gunnar and Svennblad, Bodil and Wiberg, Bernice},
  issn         = {1464-3685},
  language     = {eng},
  number       = {6},
  pages        = {2018--2025},
  publisher    = {Oxford University Press},
  series       = {International Journal of Epidemiology},
  title        = {Risk factors for subarachnoid haemorrhage : a nationwide cohort of 950 000 adults},
  url          = {http://dx.doi.org/10.1093/ije/dyz163},
  doi          = {10.1093/ije/dyz163},
  volume       = {48},
  year         = {2019},
}