Association of Diabetes and Glycated Hemoglobin With the Risk of Intracerebral Hemorrhage: A Population-Based Cohort Study
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Tables
- Table 1
Baseline characteristics of the study population
Cohort without diabetes Cohort with diabetes n 1,167,585 297,486 Age (years) 58.5 ± 13.2 66.4 ± 11.9 Sex Male 529,290 (45.3) 142,899 (48.0) Female 638,295 (54.7) 154,587 (52.0) Ethnicity Jewish 1,001,860 (85.8) 243,386 (81.8) Arab 165,725 (14.2) 54,100 (18.2) District A 107,553 (9.2) 27,530 (9.3) B 116,468 (10.0) 31,373 (10.5) C 128,347 (11.0) 32,241 (11.2) D 132,152 (11.3) 33,167 (11.1) E 215,838 (18.5) 54,200 (18.2) F 132,548 (11.4) 3,511 (10.9) G 161,533 (13.8) 40,027 (13.5) H 173,146 (14.8) 45,437 (15.3) SES Low 418,133 (36.0) 124,733 (42.1) Middle 478,101 (41.2) 118,313 (39.9) High 265,563 (22.9) 53,353 (18.0) Comorbidities and risk factors (%) Smoking 420,800 (36.0) 113,445 (38.1) Alcohol consumption 9,155 (0.8) 2,453 (0.8) Obesity 179,141 (15.3) 121,404 (40.8) Previous ICH 1,418 (0.12) 886 (0.3) Previous stroke/TIA 54,122 (4.6) 38,850 (13.1) Hypertension 363,171 (31.1) 208,451 (70.1) Atrial fibrillation 39,763 (3.4) 23,156 (7.8) Congestive heart failure 22,186 (1.9) 23,724 (8.0) Vascular disease 89,176 (7.6) 61,295 (20.6) Chronic kidney disease 40,088 (3.4) 57,834 (19.4) Chronic obstructive lung disease 46,874 (4.0) 24,225 (8.1) Chronic liver disease 6,965 (0.6) 5,276 (1.8) Medication use (%) Antiaggregants 206,869 (17.7) 163,008 (54.8) Anticoagulants 23,001 (2.0) 14,021 (4.7) ACE inhibitors and ARBs 215,728 (18.5) 184,155 (61.9) β-Blockers 182,221 (15.6) 114,021 (38.3) Calcium channel blockers 129,544 (11.1) 87,504 (29.4) Digoxin 3,757 (0.3) 3,404 (1.1) Diuretics 109,518 (9.4) 74,283 (25.0) Antiarrhythmics 14,119 (1.2) 7.033 (2.4) Statins 333,787 (28.6) 206,126 (69.3) Cholesterol level Total cholesterol 192 ± 37 174 ± 39 LDL cholesterol 115 ± 31 96 ± 31 HDL cholesterol 51 ± 13 46 ± 12 Number of medical services used in previous year Primary physician visits 12.2 ± 10.7 20.5 ± 12.7 Cardiologist visits 0.18 ± 0.77 0.39 ± 1.11 Inpatient visits 0.22 ± 0.93 0.55 ± 1.75 Emergency visits 0.20 ± 0.63 0.29 ± 0.740 Data are means ± SD or n (%) unless otherwise indicated. ARB, angiotensin receptor blocker.
- Table 2
Descriptive statistics, incidence density rate, and crude HRs for the association between diabetes, HbA1c, and ICH
No. of patients No. of events Follow-up duration (person-years) Incidence rate (per 100,000 person-years) Crude HR (95% CI) No diabetes 1,167,585 2,556 8,684,976 29.4 Reference Diabetes 297,486 1,614 2,045,939 78.9 2.69 (2.53–2.87) Diabetes duration* ≤5 years 129,192 554 932,180 59.4 2.02 (1.85–2.20) >5 years 168,294 1,060 1,113,758 95.2 3.26 (3.03–3.50) HbA1c deciles* ≤6.0% (≤42 mmol/mol) 37,563 201 246,740 81.5 2.79 (2.41–3.22) 6.0–6.3% (42–45 mmol/mol) 32,555 157 225,209 69.7 2.38 (2.02–2.80) 6.3–6.5% (45–48 mmol/mol) 30,121 134 210,952 63.5 2.17 (1.82–2.58) 6.5–6.7% (48–50 mmol/mol) 29,955 124 209,700 59.1 2.02 (1.68–2.41) 6.7–6.9% (50–52 mmol/mol) 25,366 131 177,440 73.8 2.52 (2.11–3.0) 6.9–7.2% (52–55 mmol/mol) 29,364 143 203,631 70.2 3.40 (2.02–2.84) 7.2–7.6% (55–60 mmol/mol) 28,709 152 197,943 76.8 2.62 (2.23–3.09) 7.6–8.1% (60–65 mmol/mol) 24,373 156 167,440 93.2 3.18 (2.71–3.74) 8.1–9.3% (65–78 mmol/mol) 31,399 201 213,880 94.0 3.21 (2.78–3.71) >9.3% (>78 mmol/mol) 28,081 215 193,003 111.4 3.80 (3.31–4.37) ↵*No diabetes is the reference.
- Table 3
Adjusted HRs (95% CI) for the association between diabetes, HbA1c, and ICH
Adjusted for age and sex Adjusted for clinically relevant risk factors† Adjusted for propensity score‡ Adjusted for DRS§ No diabetes Reference Reference Reference Reference Diabetes 1.84 (1.73–1.96) 1.51 (1.40–1.62) 1.47 (1.36–1.59) 1.36 (1.27–1.45) Diabetes duration* ≤5 years 1.53 (1.40–1.68) 1.33 (1.21–1.46) 1.27 (1.15–1.41) 1.23 (1.12–1.35) >5 years 2.06 (1.91–2.21) 1.64 (1.51–1.78) 1.65 (1.50–1.80) 1.44 (1.34–1.56) HbA1c deciles* ≤6.0% (≤42 mmol/mol) 1.79 (1.55–2.07) 1.41 (1.22–1.64) 1.63 (1.40–1.89) 1.26 (1.09–1.46) 6.0–6.3% (42–45 mmol/mol) 1.49 (1.27–1.76) 1.27 (1.08–1.50) 1.37 (1.16–1.62) 1.16 (0.98–1.36) 6.3–6.5% (45–48 mmol/mol) 1.35 (1.40–1.61) 1.18 (0.99–1.41) 1.26 (1.05–1.51) 1.09 (0.91–1.29) 6.5–6.7% (48–50 mmol/mol) 1.26 (1.05–1.51) 1.08 (0.90–1.30) 1.16 (0.96–1.39) 0.98 (0.82–1.18) 6.7–6.9% (50–52 mmol/mol) 1.59 (1.33–1.90) 1.38 (1.16–1.65) 1.40 (1.16–1.67) 1.25 (1.05–1.49) 6.9–7.2% (52–55 mmol/mol) 1.54 (1.30–1.82) 1.30 (1.10–1.55) 1.28 (1.08–1.53) 1.17 (0.99–1.39) 7.2–7.6% (55–60 mmol/mol) 1.73 (1.47–2.04) 1.46 (1.23–1.73) 1.37 (1.16–1.63) 1.29 (1.10–1.52) 7.6–8.1% (60–65 mmol/mol) 2.26 (1.92–2.65) 1.86 (1.57–2.19) 1.63 (1.38–1.93) 1.62 (1.38–1.90) 8.1–9.3% (65–78 mmol/mol) 2.52 (2.19–2.91) 1.98 (1.71–2.30) 1.62 (1.39–1.88) 1.69 (1.46–1.95) >9.3% (>78 mmol/mol) 3.78 (3.29–4.35) 2.90 (2.51–3.36) 2.05 (1.77–2.37 2.46 (2.14–2.82) ↵†Adjusted for age, sex, ethnicity, SES, alcohol consumption, smoking, obesity, previous ICH, previous stroke/TIA, atrial fibrillation, congestive heart failure, vascular disease, hypertension, chronic kidney disease, chronic liver disease, LDL cholesterol, HDL cholesterol, and use of antiaggregants, anticoagulants, and statins.
↵‡The propensity score (probability of having diabetes) was calculated using a logistic regression model that included all variables in Table 1.
↵§DRS, a summary measure of ICH probability, was calculated using a Cox proportional hazards regression model that included all variables in Table 1.
↵*No diabetes is the reference.
- Table 4
Adjusted HRs (95% CI) for the association between HbA1c and ICH among patients with diabetes
Adjusted for age and sex Adjusted for clinically relevant risk factors† Adjusted for DRS§ HbA1c continuous variable* 1.17 (1.13–1.20) 1.15 (1.12–1.19) 1.14 (1.10–1.17) HbA1c deciles (D) D1: ≤6.0% (≤42 mmol/mol) 1.41 (1.13–1.76) 1.31 (1.05–1.64) 1.27 (1.01–1.59) D2: 6.0–6.3% (42–45 mmol/mol) 1.19 (0.94–1.50) 1.17 (0.93–1.49) 1.17 (0.92–1.48) D3: 6.3–6.5% (45–48 mmol/mol) 1.07 (0.74–1.37) 1.09 (0.85–1.39) 1.10 (0.86–1.40) D4: 6.5–6.7% (48–50 mmol/mol) 1.0 (reference) 1.0 (reference) 1.0 (reference) D5: 6.7–6.9% (50–52 mmol/mol) 1.25 (0.98–1.60) 1.27 (1.0–1.63) 1.27 (0.99–1.62) D6: 6.9–7.2% (52–55 mmol/mol) 1.21 (0.95–1.54) 1.20 (0.94–1.52) 1.18 (0.93–1.51) D7: 7.2–7.6% (55–60 mmol/mol) 1.35 (1.06–1.71) 1.33 (1.05–1.69) 1.30 (1.02–1.64) D8: 7.6–8.1% (60–65 mmol/mol) 1.71 (1.35–2.17) 1.66 (1.31–2.12) 1.60 (1.26–2.03) D9: 8.1–9.3% (65–78 mmol/mol) 1.86 (1.48–2.33) 1.73 (1.38–2.17) 1.63 (1.30–2.03) D10: >9.3% (>78 mmol/mol) 2.59 (2.07–3.23) 2.38 (1.90–2.99) 2.19 (1.75–2.73) The reference categories appear in boldface type.
↵†Adjusted for age, sex, ethnicity, SES, alcohol consumption, smoking, obesity, previous ICH, previous stroke/TIA, atrial fibrillation, congestive heart failure, vascular disease, hypertension, chronic kidney disease, chronic liver disease, LDL cholesterol, HDL cholesterol, and use of antiaggregants, anticoagulants, and statins.
↵§DRS, a summary measure of ICH probability, was calculated using a Cox proportional hazards regression model that included all variables in Table 1.
↵*HR for each 1% increase in HbA1c.
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