ABSTRACT

Purpose

To investigate whether subconjunctival hemorrhage (SCH) raises the risk of subsequent stroke or acute myocardial infarction (AMI) in the general population.

Methods

Using the National Health Insurance Service-National Sample Cohort database records from 2002 to 2013. Of 1,025,340 individuals in the database, we included 703,090 aged ≥ 20 years old without any history of SCH, cerebrovascular diseases, and ischemic heart diseases in the analyses. Of these, we identified 46,251 cases of incident SCH and regarded it as a time-varying covariate. We performed sensitivity analyses using 1:4 propensity score (PS)-based matched controls. To adjust for potential confounders, we investigated Cox regression models using defined demographic information, comorbidities, co-medications, and the Charlson Comorbidity Index score.

Results

The SCH group showed higher incidence probability of stroke or AMI than the general population (3.17% versus 2.71%, respectively; p < .001); however, when compared to the PS-based matched controls, there was no difference (3.17% versus 3.03%, respectively; p = .76). Time-varying covariate Cox regression analyses without adjusting for confounders showed that SCH was associated with increased risk of subsequent stroke or AMI; however, after adjusting for confounders, SCH did not increase the risk of stroke or AMI.

Conclusion

This population-based cohort study showed that SCH itself is not a risk factor for stroke or AMI. Clinicians could reassure patients with SCH that it would not increase the risk for stroke or AMI. We recommend attentive evaluation of underlying diseases for patients with SCH for identifying risk factors of stroke or AMI.

中文翻译：

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结膜下出血中风或急性心肌梗死的风险：一项全国队列研究

摘要

目的

调查结膜下出血 (SCH) 是否会增加普通人群随后发生中风或急性心肌梗死 (AMI) 的风险。

方法

使用 National Health Insurance Service-National Sample Cohort 数据库记录从 2002 年到 2013 年。在数据库中的 1,025,340 人中，我们在分析中纳入了 703,090 名年龄≥ 20 岁且没有任何 SCH、脑血管疾病和缺血性心脏病病史的人。其中，我们确定了 46,251 例 SCH 事件并将其视为随时间变化的协变量。我们使用基于 1:4 倾向评分 (PS) 的匹配对照进行了敏感性分析。为了调整潜在的混杂因素，我们使用定义的人口统计信息、合并症、联合用药和 Charlson 合并症指数评分研究了 Cox 回归模型。

结果

SCH 组中风或 AMI 的发生概率高于一般人群（分别为 3.17% 和 2.71%；p < .001）；然而，与基于 PS 的匹配对照相比，没有差异（分别为 3.17% 和 3.03%；p = .76）。不调整混杂因素的时变协变量 Cox 回归分析表明，SCH 与随后发生中风或 AMI 的风险增加有关；然而，在调整混杂因素后，SCH 并未增加中风或 AMI 的风险。

结论

这项基于人群的队列研究表明，SCH 本身并不是中风或 AMI 的危险因素。临床医生可以让 SCH 患者放心，它不会增加中风或 AMI 的风险。我们建议仔细评估 SCH 患者的基础疾病，以确定卒中或 AMI 的危险因素。