tetano
Editor, Senior Moderator
Front Med (Lausanne)
. 2022 May 19;9:811021.
doi: 10.3389/fmed.2022.811021. eCollection 2022.
Influenza Vaccination and Risk of Stroke in Women With Chronic Obstructive Pulmonary Disease: A Nationwide, Population-Based, Propensity-Matched Cohort Study
Chun-Chao Chen[SUP] 1 2 3 [/SUP], Cheng-Hsin Lin[SUP] 2 4 5 [/SUP], Chun-Chih Chiu[SUP] 1 2 [/SUP], Tsung Yeh Yang[SUP] 1 2 [/SUP], Min-Huei Hsu[SUP] 6 7 [/SUP], Yuan-Hung Wang[SUP] 8 [/SUP], Meng-Huan Lei[SUP] 9 [/SUP], Hsien Tang Yeh[SUP] 10 [/SUP], Yu-Ann Fang[SUP] 1 2 [/SUP], Wen-Rui Hao[SUP] 1 2 3 11 [/SUP], Ju-Chi Liu[SUP] 1 2 3 11 [/SUP]
Affiliations
Abstract
Backgrounds: The risk of stroke is higher among patients with chronic obstructive pulmonary disease (COPD) than among the healthy population. Moreover, women generally have worse long-term stroke outcomes than men.
Methods: The data of 6681 women with COPD (aged ≥ 65 years) registered in Taiwan's National Health Insurance Research Database were retrospectively analyzed from January 1, 2001 to December 31, 2011. After 1:1 propensity score matching, the patients were divided into vaccinated and unvaccinated groups.
Results: In total, 5102 women were enrolled. The vaccinated group had a significantly lower risk of total, hemorrhagic, and ischemic stroke than the unvaccinated group (adjusted hazard ratio [aHR]: 0.60, 95% confidence interval [CI]: 0.54-0.67; aHR: 0.59, 95% CI: 0.43-0.83; and aHR: 0.59, 95% CI: 0.52-0.68, respectively). A lower risk of stroke was observed among the women aged 65-74 and ≥75 years, and the association was dose-dependent in all types of stroke (aHR: 1.08, 95% CI: 0.92-1.26; aHR: 0.70, 95% CI: 0.60-0.82; and aHR: 0.32, 95% CI: 0.26-0.38 for those vaccinated 1, 2 to 3, and ≥4 times, respectively, during the follow-up period). Women with a CHA[SUB]2[/SUB]DS[SUB]2[/SUB]-VASc score (conditions and characteristics included congestive heart failure, hypertension, diabetes, stroke, vascular disease, age, and sex) of 2-3 and ≥4 had a significantly lower risk of ischemic stroke while receiving more vaccinations. A smaller significant lower risk of hemorrhagic stroke after more than 4 times of vaccination was noted in the women with a CHA[SUB]2[/SUB]DS[SUB]2[/SUB]-VASc score of ≥4. Both interrupted and non-interrupted vaccination was associated with lower risk of stroke occurrence.
Conclusion: Influenza vaccination is associated with a lower risk of total, hemorrhagic, and ischemic stroke among women with COPD, and the association is dose-dependent. However, the findings may be limited by unmeasurable confounders. Further investigations on this subject are warranted.
Keywords: COPD; hemorrhagic stroke; influenza vaccination; ischemic stroke; women.
. 2022 May 19;9:811021.
doi: 10.3389/fmed.2022.811021. eCollection 2022.
Influenza Vaccination and Risk of Stroke in Women With Chronic Obstructive Pulmonary Disease: A Nationwide, Population-Based, Propensity-Matched Cohort Study
Chun-Chao Chen[SUP] 1 2 3 [/SUP], Cheng-Hsin Lin[SUP] 2 4 5 [/SUP], Chun-Chih Chiu[SUP] 1 2 [/SUP], Tsung Yeh Yang[SUP] 1 2 [/SUP], Min-Huei Hsu[SUP] 6 7 [/SUP], Yuan-Hung Wang[SUP] 8 [/SUP], Meng-Huan Lei[SUP] 9 [/SUP], Hsien Tang Yeh[SUP] 10 [/SUP], Yu-Ann Fang[SUP] 1 2 [/SUP], Wen-Rui Hao[SUP] 1 2 3 11 [/SUP], Ju-Chi Liu[SUP] 1 2 3 11 [/SUP]
Affiliations
- PMID: 35665329
- PMCID: PMC9160371
- DOI: 10.3389/fmed.2022.811021
Abstract
Backgrounds: The risk of stroke is higher among patients with chronic obstructive pulmonary disease (COPD) than among the healthy population. Moreover, women generally have worse long-term stroke outcomes than men.
Methods: The data of 6681 women with COPD (aged ≥ 65 years) registered in Taiwan's National Health Insurance Research Database were retrospectively analyzed from January 1, 2001 to December 31, 2011. After 1:1 propensity score matching, the patients were divided into vaccinated and unvaccinated groups.
Results: In total, 5102 women were enrolled. The vaccinated group had a significantly lower risk of total, hemorrhagic, and ischemic stroke than the unvaccinated group (adjusted hazard ratio [aHR]: 0.60, 95% confidence interval [CI]: 0.54-0.67; aHR: 0.59, 95% CI: 0.43-0.83; and aHR: 0.59, 95% CI: 0.52-0.68, respectively). A lower risk of stroke was observed among the women aged 65-74 and ≥75 years, and the association was dose-dependent in all types of stroke (aHR: 1.08, 95% CI: 0.92-1.26; aHR: 0.70, 95% CI: 0.60-0.82; and aHR: 0.32, 95% CI: 0.26-0.38 for those vaccinated 1, 2 to 3, and ≥4 times, respectively, during the follow-up period). Women with a CHA[SUB]2[/SUB]DS[SUB]2[/SUB]-VASc score (conditions and characteristics included congestive heart failure, hypertension, diabetes, stroke, vascular disease, age, and sex) of 2-3 and ≥4 had a significantly lower risk of ischemic stroke while receiving more vaccinations. A smaller significant lower risk of hemorrhagic stroke after more than 4 times of vaccination was noted in the women with a CHA[SUB]2[/SUB]DS[SUB]2[/SUB]-VASc score of ≥4. Both interrupted and non-interrupted vaccination was associated with lower risk of stroke occurrence.
Conclusion: Influenza vaccination is associated with a lower risk of total, hemorrhagic, and ischemic stroke among women with COPD, and the association is dose-dependent. However, the findings may be limited by unmeasurable confounders. Further investigations on this subject are warranted.
Keywords: COPD; hemorrhagic stroke; influenza vaccination; ischemic stroke; women.