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- Title
Risk factors for subarachnoid haemorrhage: a nationwide cohort of 950 000 adults.
- Authors
Sundström, Johan; Söderholm, Martin; Söderberg, Stefan; Alfredsson, Lars; Andersson, Martin; Bellocco, Rino; Björck, Martin; Broberg, Per; Eriksson, Maria; Eriksson, Marie; Forsberg, Bertil; Fransson, Eleonor I; Giedraitis, Vilmantas; Theorell-Haglöw, Jenny; Hallqvist, Johan; Hansson, Per-Olof; Heller, Susanne; Håkansson, Niclas; Ingelsson, Martin; Janson, Christer
- Abstract
<bold>Background: </bold>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.<bold>Methods: </bold>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.<bold>Results: </bold>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.<bold>Conclusions: </bold>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.
- Subjects
SWEDEN; SUBARACHNOID hemorrhage; HYPOTENSION; BODY mass index; HYPERTENSION; ADULTS; HYPERTENSION epidemiology; COMPARATIVE studies; CAUSES of death; RESEARCH methodology; MEDICAL cooperation; REGRESSION analysis; RESEARCH; SEX distribution; SMOKING; EVALUATION research; EDUCATIONAL attainment; ACQUISITION of data
- Publication
International Journal of Epidemiology, 2019, Vol 48, Issue 6, p2018
- ISSN
0300-5771
- Publication type
journal article
- DOI
10.1093/ije/dyz163