title: Decreased risk of stroke in patients with traumatic brain injury receiving acupuncture treatment: a population-based retrospective cohort study.
abstract: BACKGROUND
  Patients with traumatic brain injury (TBI) face increased risk of stroke. Whether acupuncture can help to protect TBI patients from stroke has not previously been studied.
  
  
  METHODS
  Taiwan's National Health Insurance Research Database was used to conduct a retrospective cohort study of 7409 TBI patients receiving acupuncture treatment and 29,636 propensity-score-matched TBI patients without acupuncture treatment in 2000-2008 as controls. Both TBI cohorts were followed until the end of 2010 and adjusted for immortal time to measure the incidence and adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) of new-onset stroke in the multivariable Cox proportional hazard models.
  
  
  RESULTS
  TBI patients with acupuncture treatment (4.9 per 1000 person-years) had a lower incidence of stroke compared with those without acupuncture treatment (7.5 per 1000 person-years), with a HR of 0.59 (95% CI = 0.50-0.69) after adjustment for sociodemographics, coexisting medical conditions and medications. The association between acupuncture treatment and stroke risk was investigated by sex and age group (20-44, 45-64, and ≥65 years). The probability curve with log-rank test showed that TBI patients receiving acupuncture treatment had a lower probability of stroke than those without acupuncture treatment during the follow-up period (p<0.0001).
  
  
  CONCLUSIONS
  Patients with TBI receiving acupuncture treatment show decreased risk of stroke compared with those without acupuncture treatment. However, this study was limited by lack of information regarding lifestyles, biochemical profiles, TBI severity, and acupuncture points used in treatments.
authors.affiliation: School of Chinese Medicine for Post-Baccalaureate, I-Shou University, Kaohsiung, Taiwan.
authors.forename: Chun-Chuan
authors.initials: CC
authors.lastname: Shih
authors.affiliation: Neuroscience Laboratory, Department of Neurology, China Medical University Hospital, Taichung, Taiwan.
authors.forename: Yi-Ting
authors.initials: YT
authors.lastname: Hsu
authors.affiliation: Graduate Institute of Integrated Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan.
authors.forename: Hwang-Huei
authors.initials: HH
authors.lastname: Wang
authors.affiliation: Department of Anesthesiology, Taipei Medical University Hospital, Taipei, Taiwan ; Health Policy Research Centre, Taipei Medical University Hospital, Taipei, Taiwan ; School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
authors.forename: Ta-Liang
authors.initials: TL
authors.lastname: Chen
authors.affiliation: School of Chinese Medicine for Post-Baccalaureate, I-Shou University, Kaohsiung, Taiwan.
authors.forename: Chin-Chuan
authors.initials: CC
authors.lastname: Tsai
authors.affiliation: School of Chinese Medicine for Post-Baccalaureate, I-Shou University, Kaohsiung, Taiwan.
authors.forename: Hsin-Long
authors.initials: HL
authors.lastname: Lane
authors.affiliation: Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan.
authors.forename: Chun-Chieh
authors.initials: CC
authors.lastname: Yeh
authors.affiliation: Department of Public Health, China Medical University, Taichung, Taiwan.
authors.forename: Fung-Chang
authors.initials: FC
authors.lastname: Sung
authors.affiliation: Graduate Institute of Injury Prevention and Control, Taipei Medical University, Taipei, Taiwan.
authors.forename: Wen-Ta
authors.initials: WT
authors.lastname: Chiu
authors.affiliation: Department of Anesthesiology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.
authors.forename: Yih-Giun
authors.initials: YG
authors.lastname: Cherng
authors.affiliation: Department of Anesthesiology, Taipei Medical University Hospital, Taipei, Taiwan ; Health Policy Research Centre, Taipei Medical University Hospital, Taipei, Taiwan ; School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan ; Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan.
authors.forename: Chien-Chang
authors.initials: CC
authors.lastname: Liao
mesh_terms: D015670:Acupuncture Therapy / Q000379:methods*; D000328:Adult; D000367:Age Factors; D000368:Aged; D001930:Brain Injuries / Q000628:therapy*; D016022:Case-Control Studies; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012737:Sex Factors; D020521:Stroke / Q000453:epidemiology* / Q000209:etiology*; D013624:Taiwan / Q000453:epidemiology