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

Journal article
Authors Johan Sundström
Martin Söderholm
Stefan Söderberg
Lars Alfredsson
Martin Andersson
Rino Bellocco
Martin Björck
Per Broberg
Maria Eriksson
Marie Eriksson
Bertil Forsberg
Eleonor I Fransson
Vilmantas Giedraitis
Jenny Theorell-Haglöw
Johan Hallqvist
Per-Olof Hansson
Susanne Heller
Niclas Håkansson
Martin Ingelsson
Christer Janson
Bengt Järvholm
Payam Khalili
Anders Knutsson
Anton Lager
Ylva Trolle Lagerros
Susanna C Larsson
Karin Leander
Jerzy Leppert
Lars Lind
Eva Lindberg
Cecilia Magnusson
Patrik K E Magnusson
Mauricio Malfert
Karl Michaëlsson
Peter Nilsson
Håkan Olsson
Nancy L Pedersen
Johanna Pennlert
Andreas Rosenblad
Annika Rosengren
Kjell Torén
Anders Wanhainen
Alicja Wolk
Gunnar Engström
Bodil Svennblad
Bernice Wiberg
Published in International journal of epidemiology
ISSN 1464-3685
Publication year 2019
Published at Institute of Medicine, Department of Molecular and Clinical Medicine
Language en
Links dx.doi.org/10.1093/ije/dyz163
www.ncbi.nlm.nih.gov/entrez/query.f...
Subject categories Clinical Medicine

Abstract

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.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.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.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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