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. 2019 Dec 1;48(6):2018-2025.
doi: 10.1093/ije/dyz163.

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

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
Affiliations

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

Johan Sundström et al. Int J Epidemiol. .

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] 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.

Keywords: Stroke; cohort study; epidemiology.

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