Association between Anemia and Stroke in Females: A Nationwide, Population-Based Cohort Study in Taiwan

Yuan Sui, Chien-Tai Hong, Li-Nien Chien, Hung-Yi Liu, Hung-Yi Chiou and Yi-Chen Hsieh
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Yuan Sui: Department of Neurology, Shuang Ho Hospital, Taipei Medical University, Taipei 11031, Taiwan
Chien-Tai Hong: Department of Neurology, Shuang Ho Hospital, Taipei Medical University, Taipei 11031, Taiwan
Li-Nien Chien: School of Health Care Administration, College of Management, Taipei Medical University, Taipei 11031, Taiwan
Hung-Yi Liu: Health and Clinical Research Data Center, Office of Data, Taipei Medical University, Taipei 11031, Taiwan
Hung-Yi Chiou: School of Public Health, College of Public Health, Taipei Medical University, Taipei 11031, Taiwan
Yi-Chen Hsieh: Master Program in Applied Molecular Epidemiology, College of Public Health, Taipei Medical University, Taipei 11031, Taiwan

IJERPH, 2020, vol. 17, issue 20, 1-12

Abstract: Optimal stroke prevention strategies for women should take into account specific sex-related stroke risk factors. Anemia is a common medical condition in females, particularly in women of reproductive age. This study investigated whether anemia is an independent risk factor for stroke in females in a population-based cohort study. We investigated newly diagnosed anemic female patients with no history of central nervous system disease, psychiatric disorders, traumatic brain injury, major operations or hemorrhagic diseases identified from the Taiwan National Health Insurance Research Database. Non-anemic matched controls (1:1) were selected based on a propensity score estimated using a logistic regression model that included demographic characteristics and comorbidities. A competing risk analysis was applied to estimate the stroke risk in anemic patients compared to that of their matched controls. In our study, the adjusted sub-distribution hazard ratios (aSHRs) of overall, hemorrhagic and ischemic stroke in anemic female patients aged <50 years were 1.35 (95% confidence interval (CI): 1.19–1.52, p < 0.001), 1.31 (95% CI, 1.09-1.56, p < 0.003), and 1.35 (95% CI, 1.15–1.58, p < 0.001), respectively, compared to non-anemic female controls. However, a positive association between anemia and stroke was not found for those aged ≥50 years. Similar results were observed when the follow-up age was limited to 50 years to reduce the potential effects of menopause on stroke. In conclusion, the present population-based cohort study found that anemia is a potential risk factor for overall, hemorrhagic and ischemic stroke in females of reproductive age.

Keywords: stroke; anemia; population-based cohort study; competing risk analysis; adjusted sub-distribution hazard ratio (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2020
References: View complete reference list from CitEc
Citations: View citations in EconPapers (2)

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