title: Increased risk of stroke after spinal cord injury: a nationwide 4-year follow-up cohort study.
abstract: OBJECTIVE
  Spinal cord injury (SCI) is associated with a higher risk of cardiovascular diseases but whether or not the risk of cerebrovascular disease also increases remains unclear. This study aimed to evaluate the incidence of stroke in patients with disability caused by SCI.
  
  
  METHODS
  Study subjects were identified from a nationwide cohort of 18,690,066 people from 1998 to 2002 that was divided into an SCI group (n = 2,806), who were disabled from SCI, and a comparison group (n = 28,060), composed of age-, sex-, and propensity score- matched control subjects. Every subject was followed up for 4 years, unless they died or had a stroke by December 31, 2006. Kaplan-Meier and Cox regression analyses were performed.
  
  
  RESULTS
  The incidence rate of stroke in the SCI group (5.96 per 1,000 person-years) was higher than that of the comparison group (p < 0.001). Stroke was more likely to occur in the SCI group than in the comparison group (crude hazard ratio 2.93, p < 0.001; adjusted hazard ratio 2.85, p < 0.001). In the SCI group, the incidence of ischemic stroke was higher than that of hemorrhagic stroke (incidence rate ratio 3.42, p < 0.001).
  
  
  CONCLUSIONS
  SCI patients with disability are at a higher risk of stroke, especially the ischemic type. Strategies to prevent stroke are therefore suggested for them.
authors.affiliation: Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.
authors.forename: Jau-Ching
authors.initials: JC
authors.lastname: Wu
authors.forename: Yu-Chun
authors.initials: YC
authors.lastname: Chen
authors.forename: Laura
authors.initials: L
authors.lastname: Liu
authors.forename: Tzeng-Ji
authors.initials: TJ
authors.lastname: Chen
authors.forename: Wen-Cheng
authors.initials: WC
authors.lastname: Huang
authors.forename: Henrich
authors.initials: H
authors.lastname: Cheng
authors.forename: Su
authors.initials: S
authors.lastname: Tung-Ping
mesh_terms: D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D013119:Spinal Cord Injuries / Q000150:complications* / Q000453:epidemiology*; D020521:Stroke / Q000453:epidemiology* / Q000209:etiology*; D014481:United States / Q000453:epidemiology; D055815:Young Adult