The long-term effect of cancer on incident stroke: A nationwide population-based cohort study in Korea

Hyun Soon Jang, Jimi Choi, Jaewon Shin, Jong Won Chung, Oh Young Bang, Gyeong Moon Kim, Woo Keun Seo, Juneyoung Lee

Research output: Contribution to journalArticle

Abstract

Background and Purpose: Despite the recent growing interest in the cancer–stroke association, the long-term effect, and organ-specific association with stroke incidence in subjects with cancer have not been clearly defined. Methods: Data were obtained from the Korean National Health Insurance Service National Sample Cohort database between 2002 and 2015. To investigate the effects of cancer on stroke incidence, subjects were classified into cancer and non-cancer groups based on the period after cancer diagnosis and origin organ of cancer. To minimize the effects of selection bias, we performed a propensity score matching analysis with covariates of demographic data, vascular risk factors, antithrombotics use and statin use. Incident stroke was diagnosed based on operational definition and classified into ischemic stroke and hemorrhagic stroke. Results: Data of 20,707 subjects with cancer and 675,594 without cancer were analyzed for 7 follow-up years. The subjects with cancer had higher risk of any stroke (subdistribution hazard ratio [SHR], 1.13; 95% confidence interval [CI], 1.02–1.26; p = 0.0181) than those without cancer. Similar trend was found for ischemic stroke (SHR, 1.17; 95% CI, 1.05–1.31; p = 0.0054), but not for hemorrhagic stroke. The risk of stroke was increased in subjects with cancer in the digestive organ, respiratory and intrathoracic organ, and “others (such as breast and female and male reproductive organs)” in 3 years; however, the association disappeared thereafter except those with “others” cancer. Chemotherapy increased the risk of ischemic stroke (SHR 1.21; 95% CI, 1.03–1.41). Conclusions: Cancer increases the risk of stroke at 3 years after the diagnosis of cancer, and the effect was maintained for 7 years. The association between cancer and stroke incidence depends on the organ from which the cancer originated and chemotherapy.

Original languageEnglish
Article number52
JournalFrontiers in Neurology
Volume10
Issue numberFebruary
DOIs
Publication statusPublished - 2019 Jan 1

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Korea
Cohort Studies
Stroke
Population
Neoplasms
National Health Programs
Confidence Intervals
Incidence
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Drug Therapy
Propensity Score
Selection Bias
Breast

Keywords

  • Cancer
  • Chemotherapy
  • Epidemiology
  • Incidence
  • Propensity score matching
  • Stroke
  • Survival

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology

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The long-term effect of cancer on incident stroke : A nationwide population-based cohort study in Korea. / Jang, Hyun Soon; Choi, Jimi; Shin, Jaewon; Chung, Jong Won; Bang, Oh Young; Kim, Gyeong Moon; Seo, Woo Keun; Lee, Juneyoung.

In: Frontiers in Neurology, Vol. 10, No. February, 52, 01.01.2019.

Research output: Contribution to journalArticle

Jang, Hyun Soon ; Choi, Jimi ; Shin, Jaewon ; Chung, Jong Won ; Bang, Oh Young ; Kim, Gyeong Moon ; Seo, Woo Keun ; Lee, Juneyoung. / The long-term effect of cancer on incident stroke : A nationwide population-based cohort study in Korea. In: Frontiers in Neurology. 2019 ; Vol. 10, No. February.
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abstract = "Background and Purpose: Despite the recent growing interest in the cancer–stroke association, the long-term effect, and organ-specific association with stroke incidence in subjects with cancer have not been clearly defined. Methods: Data were obtained from the Korean National Health Insurance Service National Sample Cohort database between 2002 and 2015. To investigate the effects of cancer on stroke incidence, subjects were classified into cancer and non-cancer groups based on the period after cancer diagnosis and origin organ of cancer. To minimize the effects of selection bias, we performed a propensity score matching analysis with covariates of demographic data, vascular risk factors, antithrombotics use and statin use. Incident stroke was diagnosed based on operational definition and classified into ischemic stroke and hemorrhagic stroke. Results: Data of 20,707 subjects with cancer and 675,594 without cancer were analyzed for 7 follow-up years. The subjects with cancer had higher risk of any stroke (subdistribution hazard ratio [SHR], 1.13; 95{\%} confidence interval [CI], 1.02–1.26; p = 0.0181) than those without cancer. Similar trend was found for ischemic stroke (SHR, 1.17; 95{\%} CI, 1.05–1.31; p = 0.0054), but not for hemorrhagic stroke. The risk of stroke was increased in subjects with cancer in the digestive organ, respiratory and intrathoracic organ, and “others (such as breast and female and male reproductive organs)” in 3 years; however, the association disappeared thereafter except those with “others” cancer. Chemotherapy increased the risk of ischemic stroke (SHR 1.21; 95{\%} CI, 1.03–1.41). Conclusions: Cancer increases the risk of stroke at 3 years after the diagnosis of cancer, and the effect was maintained for 7 years. The association between cancer and stroke incidence depends on the organ from which the cancer originated and chemotherapy.",
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T2 - A nationwide population-based cohort study in Korea

AU - Jang, Hyun Soon

AU - Choi, Jimi

AU - Shin, Jaewon

AU - Chung, Jong Won

AU - Bang, Oh Young

AU - Kim, Gyeong Moon

AU - Seo, Woo Keun

AU - Lee, Juneyoung

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AB - Background and Purpose: Despite the recent growing interest in the cancer–stroke association, the long-term effect, and organ-specific association with stroke incidence in subjects with cancer have not been clearly defined. Methods: Data were obtained from the Korean National Health Insurance Service National Sample Cohort database between 2002 and 2015. To investigate the effects of cancer on stroke incidence, subjects were classified into cancer and non-cancer groups based on the period after cancer diagnosis and origin organ of cancer. To minimize the effects of selection bias, we performed a propensity score matching analysis with covariates of demographic data, vascular risk factors, antithrombotics use and statin use. Incident stroke was diagnosed based on operational definition and classified into ischemic stroke and hemorrhagic stroke. Results: Data of 20,707 subjects with cancer and 675,594 without cancer were analyzed for 7 follow-up years. The subjects with cancer had higher risk of any stroke (subdistribution hazard ratio [SHR], 1.13; 95% confidence interval [CI], 1.02–1.26; p = 0.0181) than those without cancer. Similar trend was found for ischemic stroke (SHR, 1.17; 95% CI, 1.05–1.31; p = 0.0054), but not for hemorrhagic stroke. The risk of stroke was increased in subjects with cancer in the digestive organ, respiratory and intrathoracic organ, and “others (such as breast and female and male reproductive organs)” in 3 years; however, the association disappeared thereafter except those with “others” cancer. Chemotherapy increased the risk of ischemic stroke (SHR 1.21; 95% CI, 1.03–1.41). Conclusions: Cancer increases the risk of stroke at 3 years after the diagnosis of cancer, and the effect was maintained for 7 years. The association between cancer and stroke incidence depends on the organ from which the cancer originated and chemotherapy.

KW - Cancer

KW - Chemotherapy

KW - Epidemiology

KW - Incidence

KW - Propensity score matching

KW - Stroke

KW - Survival

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