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Risk factors for subarachnoid haemorrhage: a nationwide cohort of 950 000 adults.
International Journal of Epidemiology ( IF 6.4 ) Pub Date : 2019-12-01 , DOI: 10.1093/ije/dyz163
Johan Sundström 1, 2 , Martin Söderholm 3 , Stefan Söderberg 4 , Lars Alfredsson 5 , Martin Andersson 4 , Rino Bellocco 6, 7 , Martin Björck 8 , Per Broberg 9 , Maria Eriksson 10 , Marie Eriksson 4, 11 , Bertil Forsberg 4 , Eleonor I Fransson 12 , Vilmantas Giedraitis 13 , Jenny Theorell-Haglöw 1 , Johan Hallqvist 13 , Per-Olof Hansson 14 , Susanne Heller 15 , Niclas Håkansson 16 , Martin Ingelsson 13 , Christer Janson 1 , Bengt Järvholm 4 , Payam Khalili 17 , Anders Knutsson 18 , Anton Lager 19, 20 , Ylva Trolle Lagerros 21, 22 , Susanna C Larsson 16 , Karin Leander 5 , Jerzy Leppert 23 , Lars Lind 1 , Eva Lindberg 1 , Cecilia Magnusson 19, 20 , Patrik K E Magnusson 7 , Mauricio Malfert 15 , Karl Michaëlsson 8 , Peter Nilsson 3 , Håkan Olsson 9 , Nancy L Pedersen 7 , Johanna Pennlert 4 , Andreas Rosenblad 23 , Annika Rosengren 14 , Kjell Torén 24 , Anders Wanhainen 8 , Alicja Wolk 16 , Gunnar Engström 3 , Bodil Svennblad 8 , Bernice Wiberg 13
Affiliation  

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.

中文翻译:

蛛网膜下腔出血的危险因素:全国范围内有950 000名成年人。

背景技术蛛网膜下腔出血(SAH)是一种破坏性疾病,其高死亡率和幸存者中的严重残疾。其原因了解甚少。我们旨在使用新型的全国性队列研究联盟调查SAH的危险因素。方法我们从21个基于人群的队列研究中,获得了25至90岁之间的949683人(330334名女性)的个人参与者数据,基线时没有SAH病史。结果来自瑞典患者和死亡原因登记处。结果在13 704 959人-年的随访中,发生了2659例首次致命或非致命的SAH,年龄标准化的发生率为9.0 [95%可信区间(CI)(7.4-10.6)/男性为100 000人-年],女性为13.8 [(11.4-16.2)/ 100 000人-年]。随着年龄的增长,发病率呈指数增长。在多变量调整的Poisson模型中,观察到当前吸烟与体重指数(BMI)的显着性相互作用。当前吸烟使女性的比率(RR)为2.24(95%CI 1.95-2.57),男性为1.62(1.47-1.79)。女性的BMI升高一个标准差会导致女性的RR为0.86(0.81-0.92),男性的RR为1.02(0.96-1.08)。较高的血压和较低的受教育水平也与较高的SAH风险相关。结论女性SAH风险比男性高45%,危险因素强度方面存在明显的性别差异。特别是,吸烟对女性的不利影响明显更强,这可能会激发有针对性的公共卫生举措。观察到当前吸烟与体重指数(BMI)的显着性相互作用。当前吸烟使女性的比率(RR)为2.24(95%CI 1.95-2.57),男性为1.62(1.47-1.79)。女性的BMI升高一个标准差会导致女性的RR为0.86(0.81-0.92),男性的RR为1.02(0.96-1.08)。较高的血压和较低的受教育水平也与较高的SAH风险相关。结论女性SAH风险比男性高45%,危险因素强度方面存在明显的性别差异。特别是,吸烟对女性的不利影响明显更强,这可能会激发有针对性的公共卫生举措。观察到当前吸烟与体重指数(BMI)的显着性相互作用。当前吸烟使女性的比率(RR)为2.24(95%CI 1.95-2.57),男性为1.62(1.47-1.79)。女性的BMI升高一个标准差会导致女性的RR为0.86(0.81-0.92),男性的RR为1.02(0.96-1.08)。较高的血压和较低的受教育水平也与较高的SAH风险相关。结论女性SAH风险比男性高45%,危险因素强度方面存在明显的性别差异。特别是,吸烟对女性的不利影响明显更强,这可能会激发有针对性的公共卫生举措。92%的女性和1.02(0.96-1.08)的男性。较高的血压和较低的受教育水平也与较高的SAH风险相关。结论女性SAH风险比男性高45%,危险因素强度方面存在明显的性别差异。特别是,吸烟对女性的不利影响明显更强,这可能会激发有针对性的公共卫生举措。92%的女性和1.02(0.96-1.08)的男性。较高的血压和较低的教育水平也与较高的SAH风险相关。结论女性SAH风险比男性高45%,危险因素强度方面存在明显的性别差异。特别是,吸烟对女性的不利影响明显更强,这可能会激发有针对性的公共卫生举措。
更新日期:2019-12-25
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