Stroke：吸烟增加中国老人出血性卒中死亡率

出血性卒中在非西方人群中更多见，通常与其他的心血管疾病没有同样的危险因素。吸烟与出血性卒中亚型之间的相关性尚未确定。为此，香港大学社区医学与公共卫生系的Lin Xu博士等人进行了一项研究，在香港的大样本老年人队列中检验吸烟与出血性卒中（包括脑出血与蛛网膜下腔出血）的相关性，研究结果在线发表在2013年5月30日的Stroke杂志上。研究结果显示：吸烟与出血性卒中死亡率强相关，特别是蛛网膜下腔出血。

研究人员使用多变量Cox回归分析评估基线吸烟情况与出血性卒中（包括亚型）死亡情况的相关性。使用人群为基础的队列，在1998年7年到2001年12月间共纳入相关特区卫生署所有的18个老年卫生中心中的66820位年龄大于65岁的中国人，并随访至2012年5月31日。

研究结果显示：在平均随访10.9年(SD=3.1)后, 共有648 人死于出血性卒中，其中530人 (82%)为脑出血。现吸烟者与较高的出血性卒中风险(风险比：2.19; 95%可信区间：1.49–3.22), 脑出血(1.94; 1.25–3.01)及蛛网膜下腔出血(3.58; 1.62–7.94)相关,校正了年龄、性别、教育、公共支持、住房类型、月支出、酒精量及运动。进一步校正高血压与体块指数后，估计值只有轻微改变。

该研究发现：吸烟与出血性卒中死亡率强相关，特别是蛛网膜下腔出血。

Smoking and Hemorrhagic Stroke Mortality in a Prospective Cohort Study of Older Chinese.
BACKGROUND AND PURPOSE
Hemorrhagic stroke is more common in non-Western settings and does not always share risk factors with other cardiovascular diseases. The association of smoking with hemorrhagic stroke subtypes has not been established. We examined the association of cigarette smoking with hemorrhagic stroke, by subtype (intracerebral hemorrhage and subarachnoid hemorrhage), in a large cohort of older Chinese from Hong Kong.
METHODS
Multivariable Cox regression analysis was used to assess the adjusted associations of smoking at baseline with death from hemorrhagic stroke and its subtypes, using a population-based prospective cohort of 66 820 Chinese aged >65 years enrolled from July 1998 to December 2001 at all the 18 Elderly Health Centers of the Hong Kong Government Department of Health and followed until May 31, 2012.
RESULTS
After follow-up for an average of 10.9 years (SD=3.1), 648 deaths from hemorrhagic stroke had occurred, of which 530 (82%) were intracerebral hemorrhage. Current smoking was associated with a higher risk of hemorrhagic stroke (hazard ratio, 2.19; 95% confidence interval, 1.49-3.22), intracerebral hemorrhage (1.94; 1.25-3.01), and subarachnoid hemorrhage (3.58; 1.62-7.94), adjusted for age, sex, education, public assistance, housing type, monthly expenditure, alcohol use, and exercise. Further adjustment for hypertension and body mass index slightly changed the estimates.
CONCLUSIONS
Smoking is strongly associated with hemorrhagic stroke mortality, particularly for subarachnoid hemorrhage.