title: Smoking and hemorrhagic stroke mortality in a prospective cohort study of older Chinese.
abstract: OBJECTIVE
  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.
authors.affiliation: Department of Community Medicine and School of Public Health, The University of Hong Kong, Hong Kong, China.
authors.forename: Lin
authors.initials: L
authors.lastname: Xu
authors.forename: Catherine Mary
authors.initials: CM
authors.lastname: Schooling
authors.forename: Wai Man
authors.initials: WM
authors.lastname: Chan
authors.forename: Siu Yin
authors.initials: SY
authors.lastname: Lee
authors.forename: Gabriel M
authors.initials: GM
authors.lastname: Leung
authors.forename: Tai Hing
authors.initials: TH
authors.lastname: Lam
mesh_terms: D000368:Aged; D002543:Cerebral Hemorrhage / Q000453:epidemiology / Q000209:etiology* / Q000401:mortality*; D006723:Hong Kong / Q000453:epidemiology; D006801:Humans; D007406:Interview, Psychological; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012306:Risk; D012907:Smoking / Q000009:adverse effects* / Q000453:epidemiology; D020521:Stroke / Q000453:epidemiology / Q000209:etiology* / Q000401:mortality; D013345:Subarachnoid Hemorrhage / Q000453:epidemiology / Q000209:etiology* / Q000401:mortality*; D013997:Time Factors
keywords: hemorrhagic; mortality; smoking; stroke