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Open AccessArticle

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

by 1,†, 1,2,†, 3,4, 4, 5,6 and 6,7,8,*
1
Department of Neurology, Shuang Ho Hospital, Taipei Medical University, Taipei 11031, Taiwan
2
Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan
3
School of Health Care Administration, College of Management, Taipei Medical University, Taipei 11031, Taiwan
4
Health and Clinical Research Data Center, Office of Data, Taipei Medical University, Taipei 11031, Taiwan
5
School of Public Health, College of Public Health, Taipei Medical University, Taipei 11031, Taiwan
6
Master Program in Applied Molecular Epidemiology, College of Public Health, Taipei Medical University, Taipei 11031, Taiwan
7
PhD Program of Neural Regenerative Medicine, College of Medical Science and Technology, Taipei Medical University, Taipei 11031, Taiwan
8
PhD Program in Biotechnology Research and Development, College of Pharmacy, Taipei Medical University, Taipei 11031, Taiwan
*
Author to whom correspondence should be addressed.
These authors contributed equally to this work.
Int. J. Environ. Res. Public Health 2020, 17(20), 7440; https://doi.org/10.3390/ijerph17207440
Received: 8 September 2020 / Revised: 5 October 2020 / Accepted: 12 October 2020 / Published: 13 October 2020
(This article belongs to the Special Issue Feature Papers in Women's Health)
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. View Full-Text
Keywords: stroke; anemia; population-based cohort study; competing risk analysis; adjusted sub-distribution hazard ratio stroke; anemia; population-based cohort study; competing risk analysis; adjusted sub-distribution hazard ratio
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MDPI and ACS Style

Sui, Y.; Hong, C.-T.; Chien, L.-N.; Liu, H.-Y.; Chiou, H.-Y.; Hsieh, Y.-C. Association between Anemia and Stroke in Females: A Nationwide, Population-Based Cohort Study in Taiwan. Int. J. Environ. Res. Public Health 2020, 17, 7440. https://doi.org/10.3390/ijerph17207440

AMA Style

Sui Y, Hong C-T, Chien L-N, Liu H-Y, Chiou H-Y, Hsieh Y-C. Association between Anemia and Stroke in Females: A Nationwide, Population-Based Cohort Study in Taiwan. International Journal of Environmental Research and Public Health. 2020; 17(20):7440. https://doi.org/10.3390/ijerph17207440

Chicago/Turabian Style

Sui, Yuan; Hong, Chien-Tai; Chien, Li-Nien; Liu, Hung-Yi; Chiou, Hung-Yi; Hsieh, Yi-Chen. 2020. "Association between Anemia and Stroke in Females: A Nationwide, Population-Based Cohort Study in Taiwan" Int. J. Environ. Res. Public Health 17, no. 20: 7440. https://doi.org/10.3390/ijerph17207440

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