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Rheumatology International

, Volume 34, Issue 2, pp 255–263 | Cite as

Increased risk of stroke among patients with ankylosing spondylitis: a population-based matched-cohort study

  • Joseph J. Keller
  • Jung-Lung Hsu
  • Shiue-Ming Lin
  • Chia-Chi Chou
  • Li-Hsuan Wang
  • Jui Wang
  • Chyi-Huey Bai
  • Hung-Yi Chiou
Original Article

Abstract

Ankylosing spondylitis (AS) is a chronic inflammatory rheumatic disease. Although two prior studies detected increased prevalence ratios of cerebrovascular disease among AS patients, the results of the two studies investigating AS and stroke are in conflict. Therefore, the present cohort study set out to estimate the risk of subsequent stroke in AS patients compared with matched controls using a population-based dataset in Taiwan. This investigation analyzed administrative claims data sourced from the Taiwan National Health Insurance Database. Our study consisted of a study cohort comprising 1,479 AS patients and a comparison cohort of 5,916 subjects without AS. Cox proportional hazards regressions were performed to estimate the risk of subsequent stroke during the follow-up period. We also conducted additional analyses investigating the risk of subsequent stroke by gender and pharmaceutical prescription. After adjusting for chronic lower respiratory diseases, type 2 diabetes mellitus, hypertension, hyperlipidemia, renal disease, coronary heart disease, atrial fibrillation, income, and urbanization, compared with comparison patients, the hazard ratio for subsequent stroke among patients with AS was 2.3 (95 % CI 1.9–2.8). We also stratified our results by both gender and pharmaceutical prescription, but did not find a statistically significant difference for the risk of subsequent stroke either between men and women, or between AS patients taking various pharmaceutical regimens and the overall AS population. This is the first study to report an increased hazard ratio for subsequent stroke among AS patients when compared with matched comparison patients without AS.

Keywords

Ankylosing spondylitis Stroke Epidemiology Taiwan 

Notes

Acknowledgments

This study is based in part on data from the National Health Insurance Research Database provided by the Bureau of National Health Insurance, Department of Health and managed by National Health Research Institutes.

Conflict of interest

The authors declare that they have no conflict of interest.

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Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Joseph J. Keller
    • 1
  • Jung-Lung Hsu
    • 5
    • 6
    • 7
  • Shiue-Ming Lin
    • 1
  • Chia-Chi Chou
    • 2
    • 3
  • Li-Hsuan Wang
    • 4
  • Jui Wang
    • 1
  • Chyi-Huey Bai
    • 1
    • 10
  • Hung-Yi Chiou
    • 1
    • 8
    • 9
  1. 1.School of Public Health, College of Public Health and NutritionTaipei Medical UniversityTaipeiTaiwan
  2. 2.Department of Internal MedicineChang Gung Memorial HospitalKeelungTaiwan
  3. 3.School of MedicineChang Gung UniversityTaoyuanTaiwan
  4. 4.School of Pharmacy, College of PharmacyTaipei Medical UniversityTaipeiTaiwan
  5. 5.Graduate Institute of Biomedical InformaticsTaipei Medical UniversityTaipeiTaiwan
  6. 6.Department of NeurologyShin Kong Wu Ho-Su Memorial HospitalTaipeiTaiwan
  7. 7.Institute of Biomedical EngineeringNational Taiwan UniversityTaipeiTaiwan
  8. 8.Stroke Research CenterTaipei Medical UniversityTaipeiTaiwan
  9. 9.Health and Clinical Research Data CenterTaipei Medical UniversityTaipeiTaiwan
  10. 10.Department of Public Health, College of MedicineTaipei Medical UniversityTaipeiTaiwan

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