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Increased risk of ischaemic stroke amongst patients with chronic osteomyelitis: a population‐based cohort study in T aiwan
Author(s) -
Tseng C.H.,
Chen J.H.,
Muo C.H.,
Chang Y.J.,
Sung F.C.,
Hsu C. Y.
Publication year - 2015
Publication title -
european journal of neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.881
H-Index - 124
eISSN - 1468-1331
pISSN - 1351-5101
DOI - 10.1111/ene.12387
Subject(s) - medicine , stroke (engine) , hazard ratio , risk factor , population , diabetes mellitus , cohort study , cohort , hyperlipidemia , proportional hazards model , confidence interval , endocrinology , mechanical engineering , environmental health , engineering
Background and purpose Inflammatory processes, which kindle endothelial dysfunction and atherosclerosis, may facilitate the development of cardiovascular disease, including ischaemic stroke. Evident stroke risk factors may not be identified in up to 40% of stroke patients, especially in the younger population. Inflammation remains to be established as a stroke risk factor. In this study, it was assessed whether chronic osteomyelitis ( COM ), an infectious disease with chronic inflammation, increases stroke risk. Methods A national insurance claim data set of 22 million enrollees in T aiwan was used to identify 18 509 patients with COM and 74 034 randomly selected age‐ and gender‐matched controls for a follow‐up period of 11 years starting 1 J anuary 2000 and ending 31 D ecember 2010. Stroke risk was analyzed using the C ox proportional hazards regression model. Results Comorbidities known to increase stroke risk, including hypertension, diabetes, hyperlipidemia, coronary heart disease and peripheral arterial disease, were more frequently noted in the COM group who had significantly greater stroke risk than the control cohort. Comparing only those without comorbidities, COM carried greater stroke risk than the control group [hazard ratio ( HR ) = 1.40, 95% confidence interval ( CI ) 1.22–1.62, P < 0.001]. The younger population carried even greater risk (age < 45, HR = 2.73, 95% CI 1.71–4.35; age > 65, HR = 1.16, 95% CI 1.02–1.31). Conclusions This is the first report linking COM to an increased risk of developing stroke. Results suggest that COM is a significant stroke risk factor and call for closer attention to this group of patients for more rigorous stroke prevention, especially in the younger age group.