Department of Neurology, Shuang Ho Hospital, Taipei Medical University, Taipei 11031, Taiwan.
Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan.
Int J Environ Res Public Health. 2020 Oct 13;17(20):7440. doi: 10.3390/ijerph17207440.
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, < 0.001), 1.31 (95% CI, 1.09-1.56, < 0.003), and 1.35 (95% CI, 1.15-1.58, < 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.
优化女性的卒中预防策略应考虑特定的与性别相关的卒中风险因素。贫血是女性中常见的医学病症，尤其是在育龄期女性中。本研究通过一项基于人群的队列研究，调查贫血是否是女性卒中的一个独立危险因素。我们从台湾全民健康保险研究数据库中调查了无中枢神经系统疾病、精神障碍、创伤性脑损伤、大手术或出血性疾病病史的新诊断贫血女性患者。根据逻辑回归模型（包括人口统计学特征和合并症）估计的倾向评分，选择非贫血匹配对照（1:1）。应用竞争风险分析估计与匹配对照组相比，贫血患者的卒中风险。在我们的研究中，年龄<50 岁的贫血女性患者的总体、出血性和缺血性卒中的校正亚分布风险比（aSHR）分别为 1.35（95%置信区间：1.19-1.52，<0.001）、1.31（95%置信区间，1.09-1.56，<0.003）和 1.35（95%置信区间，1.15-1.58，<0.001），与非贫血女性对照组相比。然而，对于年龄≥50 岁的患者，贫血与卒中之间没有发现正相关关系。当随访年龄限制在 50 岁以下以减少绝经对卒中的潜在影响时，观察到了类似的结果。总之，本基于人群的队列研究发现，贫血是育龄期女性总体、出血性和缺血性卒中的潜在危险因素。
