Published Online
on December 1, 2003

A more recent version of this article appeared on December 1, 2003

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Submitted on August 15, 2003
Accepted on September 3, 2003

Risk Factors for Fatal Subarachnoid Hemorrhage. The Japan Collaborative Cohort Study

Shigeki Yamada MD; Akio Koizumi MD^*; Hiroyasu Iso MD; Yasuhiko Wada MD; Yoshiyuki Watanabe MD; Chigusa Date MD; Akio Yamamoto MD; Shogo Kikuchi MD; Yutaka Inaba MD; Hideaki Toyoshima MD; Takaaki Kondo MD; Akiko Tamakoshi MD; and for the JACC Study Group

From the Department of Health and Environmental Sciences (S.Y., A.K.) and the Department of Neurosurgery (S.Y.), Kyoto University Graduate School of Medicine, Kyoto; the Department of Public Health Medicine (H.I.), Institute of Community Medicine, University of Tsukuba, Ibaraki; the Department of Hygiene (Y. Wada), Hyogo College of Medicine, Hyogo; the Department of Epidemiology for Community Health and Medicine (Y. Watanabe), Kyoto Prefectural University of Medicine Graduate School of Medical Science, Kyoto; the Department of Human Environmental Science (C.D.), Mukogawa Women’s University, Hyogo; the Department of Epidemiology (A.Y.), Tokyo Medical and Dental University, Tokyo; Department of Public Health (S.K.), Aichi Medical University, Aichi; and the Department of Epidemiology and Environmental Health (Y.I.), Juntendo Medical University, Tokyo; the Department of Public Health/Health Information Dynamics (H.T., T.K.) and the Department of Preventive Medicine/Biostatistics and Medical Decision Making (A.T.), Nagoya University Graduate School of Medicine, Nagoya, Japan.

^* To whom correspondence should be addressed. E-mail: koizumi{at}pbh.med.kyoto-u.ac.jp.

Background and Purpose--The present study aimed to identify risk factors for mortality due to subarachnoid hemorrhage (SAH) using a comprehensive questionnaire from the Japan Collaborative Cohort (JACC) Study, a Japan-wide population-based prospective study.

Methods--A total of 109 293 individuals (45 551 men and 63 742 women, aged 40 to 79 years) free of stroke at entry participated in the JACC Study between 1988 and 1990. Participants were followed up annually until they died or moved away from the surveyed community, or until the end of 1999. A diagnosis of death from SAH was based on the International Classification of Diseases, 10th revision (ICD-10). The age-adjusted univariate and multivariate hazard ratios (HR) and 95% confidence intervals (CI) of various factors were calculated in sex-stratified and sex-specific analyses using the Cox proportional hazards regression model.

Results--A total of 244 individuals (88 men and 156 women) died from SAH during the follow-up of 1 086 963 person-years. Our univariate analyses confirmed that preference for salty foods and history of blood transfusion, as well as hypertension, family history of stroke, cigarette smoking, heavy alcohol consumption, and low BMI, had statistically significant associations with mortality due to SAH. Multivariable analyses revealed that history of blood transfusion was an independent significant risk factor (HR=4.2 [95%CI, 2.1 to 8.5]) for men, while preference for salty foods or heavy drinking were not.

Conclusions--History of blood transfusion was found to be an independent risk. The association between SAH and blood transfusion warranted further study.

Key words: blood transfusion • cohort studies • risk factors • subarachnoid hemorrhage

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