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Estimated and observed mean trajectory of haemoglobin over age (crosses = estimated subject-specific mean trajectory; dashed line with dots = observed mean trajectory; dashed line = 95% confidence interval of the observed mean)
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Background:
Studies have demonstrated that high or low haemoglobin increases the risk of stroke. Previous studies, however, performed only a limited number of haemoglobin measurements, while there are dynamic haemoglobin changes over the course of a lifetime. This longitudinal cohort study aimed to classify the long-term trajectory of haemoglobin...
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Citations
... Panwar et al. demonstrated that the likelihood of stroke in women increased by a factor of 0.59 for every unit decrease in hemoglobin levels (4). The study also indicates that a gradual decline in hemoglobin levels over time may elevate stroke risk, with a Hazard Ratio (HR) of 4.12 (95% Confidence Interval: 1.50, 11.28) in men (27). In the study investigating the connection between chronic kidney disease and stroke, it is found that individuals with anemia had a significantly higher risk of stroke compared to those without anemia (HR 5.43; 95% CI 2.04 to 14.41) (28). ...
Background
The relationship between hemoglobin concentration and stroke has garnered significant interest in the research community. However, findings from published observational epidemiological studies on this relationship have been inconclusive. By using publicly available genome-wide association study (GWAS) aggregated statistics, a two-sample Mendelian randomization analysis is conducted to explore the causal relationship between hemoglobin concentration and stroke.
Methods
Summary statistics data from UK Biobank for hemoglobin concentration and from the FinnGen R9 and MEGASTROKE consortium for stroke are used. A series of quality control steps are taken to select eligible instrumental SNPs closely related to exposure. In order to make the conclusion more robust and reliable, several robust analysis methods are employed including inverse variance weighted, weighted median, MR-Egger regression, which are based on different assumptions of two-sample MR Analysis. Meanwhile, sensitivity analyses such as pleiotropy test and MR-Egg regression, are performed to mitigate horizontal pleiotropy and heterogeneity.
Results
The two-sample Mendelian randomized study indicates a negative association between hemoglobin concentration and stroke, suggesting that hemoglobin concentration acts as a protective factor against stroke. From the FinnGen database, there is a negative association between hemoglobin concentration and stroke, with an odds ratio (OR) of 0.82 and a 95% confidence interval (CI) of 0.73–0.92, p = 0.0006. Similarly, the MEGASTROKE database findings reinforce this observation. The negative association between hemoglobin concentration and stroke (OR: 0.91, 95%CI: 0.83–1.00, p = 0.040), ischemic stroke (OR: 0.87, 95%CI: 0.79–0.96, p = 0.004), and cardiogenic stroke (OR: 0.82, 95% CI: 0.69–0.99, p = 0.039) further suggests that higher hemoglobin levels might confer a protective effect against these conditions.
Conclusion
Hemoglobin concentration serves as a protective factor against stroke, and managing abnormal hemoglobin levels can effectively reduce the incidence of stroke.
... According to a study by Heo Jet al 6 , having anemia increases the probability of having an isch-Natio H et al reported 2 cases of ischemic stroke secondary to iron deficiency anemia because of bleeding from fibroid 22. According to other research, patients with a trend toward falling hemoglobin levels have a substantially higher chance of developing an ischemic stroke than those with stable hemoglobin levels that show no change 23 . The most prevalent anemia in the world, iron deficiency anemia, has been linked to ischemic stroke in earlier research 6 . ...
Objective: To determine the frequency of iron deficiency anemia in ischemic stroke. Methods: Total 200 patients with ischemic stroke were included. Investigations including Hemoglobin, Mean Corpuscular Volume (MCV), MeanCorpuscular Hemoglobin (MCH), Mean Corpuscular Hemoglobin Concentration (MCHC) serum iron level, and serum ferritin level, Total Iron Binding Capacity (TIBC), White Blood Cell (WBC) count andplatelets count (PC) were done. CT scan of brain was also done.Mean±SD were evaluated for quantitative variables which were distributed normally. However, median with inter-quartile range were evaluated for quantitative variables which were non-normally distributed. Data was compiled using SPSS version 25. To check normality of data, Shapiro-Wilk test was applied. To compare the association of qualitative variables, Chi-square test was used. Pvalue ?0.05 was considered as statistically significant. Results: In our study, out of 200 patients having ischemic stroke, 156 (78%) patients were found with iron deficiency and 44 (22%) did not have iron deficiency. Total 164 (82%) patients were anemic and 36 (18%) did not have anemia. The results showed significant mean ranks for Ferritin (p<0.001), Iron (p<0.001), Hemoglobin(p<0.001), Mean Corpuscular Volume(p<0.001), Mean Cell Hemoglobin(p<0.001), Mean Corpuscular Hemoglobin Concentration(p<0.001), and Total Iron Binding Capacity(p=0.005) with respect to iron deficiency, however White Blood Count (p=0.417) and platelet counts (p=0.511) did not have significant mean rank with respect to iron deficiency. As far as anemia is concerned, significant mean ranks was observed for Ferritin (p=0.002), Iron (p<0.001), Hemoglobin (p<0.001), Mean Corpuscular Volume (p<0.001), Mean Cell Hemoglobin (p<0.001), and Mean Corpuscular Hemoglobin Concentration (p<0.001). However, white blood count (p=0.270), platelet counts (p=0.320), and Total Iron Binding Capacity (p=0.535) did not have significant mean rank. .A significant association of iron deficiency with anemia (p<0.001) was also observed Conclusion: Study results show thatsignificant number ofischemic stroke patients have iron deficiency anemia.
... Low hemoglobin on admission is associated with longer stay in the acute care hospital [20]. Dayimu et al. suggested that long-term decreasing hemoglobin levels might increase the risk of stroke [21]. In our study, also, anemia was present in a significant number of patients (63%), which may be due to nutritional deficiency as most of the patients have low socioeconomic status and renal disease. ...
Introduction
Stroke is a devastating and disabling cerebrovascular disease with a significant amount of residual deficit. The prevalence of stroke is in a rising trend in India. Larger studies are needed for the evaluation of risk factors.
Material and methods
This cross-sectional study aimed to assess the clinical profile of patients with stroke. The demographic details of the patients were taken, comorbidities were noted, and laboratory tests were done.
Observation
The most common age group who presented with stroke was 61-80 years, followed by 41-60 years, comprising 47% and 46%, respectively. Ischemic stroke was more common (60%) than hemorrhagic stroke (40%). Male patients were more than female patients. Alcohol, smoking, hypertension, diabetes, anemia, and proteinuria were present in the study group.
Conclusion
Regular evaluation of blood pressure, blood sugar, lipid profile, and proteinuria should be routinely done in patients with diabetes and hypertension who are more than 40 years old.
... 22 Another important principle is the average posterior probability (AvePP) of each group, which has been recommended to be at least 0.70. 36 AvePP ≥ 0.7 indicates that the proportions of subjects classified in each group were not ambiguous. 37 The last common diagnostic criterion is the odds of correct classification (OCC = AvePP/1 − AvePP), and increased OCC indicates the better assignment accuracy of group classification. ...
The neurotoxic effects of prenatal exposure to per- and polyfluoroalkyl substances (PFAS) on offspring animals are well-documented. However, epidemiological evidence for legacy PFAS is inconclusive, and for alternative PFAS, it is little known. In this investigation, we selected 718 mother-child pairs from the Chinese Maoming Birth Cohort Study and measured 17 legacy and alternative PFAS in the third-trimester serum. Neuropsychological developments (communication, gross motor function, fine motor function, problem solving ability, and personal-social skills) were assessed at 3, 6, 12, 18, 24, and 36 months using the Ages and Stages Questionnaires 3rd edition. Trajectories of each subscale were classified into persistently low and persistently high groups via group-based trajectory modeling. Logistic regression and grouped weighted quantile sum were fitted to assess the potential effects of individual PFAS and their mixtures, respectively. Higher linear PFHxS levels were associated with elevated odds for the persistently low trajectories of communication (OR = 1.73; 95% CI: 1.12, 2.66) and problem solving ability (OR = 2.11; 95% CI: 1.14, 3.90). Similar findings were observed for linear PFOS, 1m-PFOS, PFDA, PFDoDA, PFUnDA, and legacy PFAS mixture. However, no association was observed for alternative PFAS and their mixture. We provided insights into the longitudinal links between prenatal legacy/alternative PFAS exposure and neuropsychological development trajectories over the first 3 years of life.
... Generalised mixed-effects models accounted for the expected withinsubject correlation between the repeated measures. Latent class mixture models (LCMMs) were used to investigate and classify the longitudinal trajectories and trends of the haematological, hepatic, and renal indices, while adjusting for age [22][23][24]. The "lcmm" package in R was used for the latent class trajectory analysis [25]. ...
Exposure to polycyclic aromatic hydrocarbons (PAHs) and volatile organic compounds (VOCs) in crude oil has carcinogenic effects on various organ systems. This longitudinal cohort study examined the effects of oil spill exposure on the haematological, hepatic, and renal profiles of Rayong oil spill clean-up workers. The sample included 869 clean-up workers from the Rayong oil spill. Latent class mixture models were used to investigate and classify the longitudinal trajectories and trends of the haematological, hepatic, and renal indices. Subgroup analysis was used to evaluate the association between the urinary metabolites of PAHs and VOCs and haematological, hepatic, and renal parameters. Most clean-up workers (97.6%) had increasing levels of white blood cells (WBCs) (0.03 × 103 cells/µL), 94.90% of the workers had a significantly increasing trend of blood urea nitrogen (0.31 mg/dL per year), and 87.20% had a significantly increasing trend of serum creatinine (0.01 mg/dL per year). A high–decreasing trend of WBCs was seen in 2.42% (−0.73 × 103 per year). Post-exposure changes in haematological, renal, and hepatic profiles are present in workers exposed to the Rayong oil spill. This indicates possible long-term health complications and worsening renal function after exposure to PAHs and VOCs in crude oil.
... This ensured that biomarker data (taken at interview) such as hemoglobin and BMI were taken a maximum of two years since contraceptive initiation, a period over which they were assumed to be relatively stable. Hemoglobin trajectories have been shown to be relatively consistent during this time frame (Dayimu et al. 2019). Only the first episode of injectable use in the last two years was included in the analysis. ...
... Second, the analysis relies on the assumption that anemia at interview is a proxy for anemia prior to or during contraceptive use. Previous studies (Dayimu et al. 2019) have indeed shown that iron trajectories are fairly stable over time, and the current analysis shows that, if anything, hemoglobin levels increase slightly with injectable use. Therefore, it is reasonable to assume that hemoglobin levels were either similar or lower at the time of injectable initiation. ...
This paper investigates the importance of women's physiological condition, alongside sociocultural factors, for predicting the risk of discontinuation of the injectable contraceptive due to side effects in Ethiopia. Contraceptive calendar data from the 2016 Ethiopian Demographic and Health Survey were analyzed. Women aged 15–49 who had initiated the injectable contraceptive in the last two years were included in the analysis (n = 1,513). Physiological factors investigated were body mass, iron status, reproductive depletion, and physical strain. After checking for reverse causality, associations between physiological and sociocultural risk factors and discontinuation due to side effects (DSE) or discontinuation due to other reasons (DOR) were estimated using multivariate Cox proportional regression analyses. Anemia status was associated with DSE, but not DOR. Anemic women were two times more at risk of DSE compared with nonanemic women (adjusted hazard ratios [aHR] = 2.38, confidence interval [CI] = 1.41–4.00). DOR was predicted by religion, wealth, and relationship status. Accounting for diversity in physiological condition is key for understanding contraceptive discontinuation due to side effects. To reduce side effects, family planning programs might benefit from providing hormonal contraception within an integrated package addressing anemia.
... A previous study has reported that the degree of hemoglobin reductionrather than the baseline hemoglobin level itself-was associated with ischemic stroke and death after surgery [21]. Other studies have reported a much higher risk of ischemic stroke development in patients who showed a tendency of decreasing hemoglobin level than in those with stable hemoglobin level with no change [22]. Our study subjects were newly diagnosed with anemia, so the hemoglobin level had likely changed recently, relating to an increased risk for ischemic stroke development within one year after their diagnosis. ...
Background:
anemia is known to be a risk factor for developing ischemic stroke in long-term follow-up studies, and it is also known to increase the risk of death in ischemic stroke patients. We aimed to determine the association of anemia with the risk of ischemic stroke and the risk of death after ischemic stroke.
Methods:
The study included patients from National Health Insurance Service cohort, from January 2005 to December 2015. Anemia patients were defined as those with confirmed diagnostic codes and related medications in the sample cohort, and patients under the age of 18 were excluded. To perform a comparative analysis with the control group, twice as many patients were extracted by propensity score matching. The effects of anemia on the development of ischemic stroke were analyzed.
Results:
A total of 58,699 patients were newly diagnosed with anemia during the study period. In anemia group, the rate of ischemic stroke occurring within 1 year was 0.550%, and the rate was 0.272% in the control group. The odds ratio of anemia related to ischemic stroke was 1.602 (95% confidence intervals (CI) 1.363-1.883). During the follow-up period, 175 out of 309 (56.6%) died in anemia group, and 130 out of 314 (41.4%) died in control group. The anemia group showed a higher risk of death than the control group (Hazard ratio 1.509, 95% CI 1.197-1.902).
Conclusion:
Analysis of the nationwide health insurance data revealed that anemia is one of the risk factors for the development of ischemic stroke, and also an independent prognostic factor affecting post-stroke mortality.
... Haemoglobin trajectories have been shown to be relatively consistent during this timeframe (Dayimu et al. 2019). Only the first episode of injectable use in the last two years was included in the analysis. ...
... Second, the analysis relies on the assumption that anaemia at interview is a proxy for anaemia prior to or during contraceptive use. Previous studies (Dayimu et al. 2019) have indeed shown that iron trajectories are fairly stable over time, and the current analysis shows that, if anything, haemoglobin levels increase slightly with injectable use. Therefore, it is reasonable to assume that haemoglobin levels were either similar or lower at the time of injectable initiation. ...
... Previous studies 19 have indeed shown that iron trajectories are fairly stable over time, and the current analysis shows that, if anything, haemoglobin levels increase slightly with injectable use. Therefore, it is reasonable to assume that anaemia levels were either similar or more severe at the time of injectable initiation. ...
... Haemoglobin trajectories have been shown to be consistent during this timeframe. 19 Only the rst episode of injectable use in the last two years was included in the analysis. We excluded women who were pregnant at the time of the interview and women who answered 'Other' for religion due to the small sample size (n = 8). ...
Introduction This paper investigates the importance of women’s physiological condition for predicting the risk of discontinuation due to side-effects of the injectable contraceptive in Ethiopia, where side-effects account for around 20% of all discontinuations.
Methods Contraceptive calendar data from the 2016 Ethiopian Demographic and Health Survey were analysed. Women aged 15-49 who had initiated the injectable contraceptive in the two years prior to interview were included in the analysis (N=1,513). After checking for reverse causality, the associations between physiological risk factors and discontinuation of the injectable contraceptive due to either side-effects (DSE) or other reasons (DOR) were estimated using multivariate Cox proportional regression analyses.
Results In 2016, 10% of women had initiated the injectable in the last two years, and 1 in 4 had discontinued use by the time of the interview. Of these, 1 in 5 discontinued due to side-effects. Women with anaemia were at twice the risk of DSE compared with non-anaemic women, while anaemia status was not associated with DOR. Sociocultural factors including religion, wealth and relationship status were significant predictors for DOR, but not for DSE.
Conclusion Accounting for diversity in physiological condition is key for understanding contraceptive discontinuation due to side-effects.
... Haemoglobin trajectories have been shown to be consistent during this timeframe. 22 Only the first episode of injectable use in the last two years was included in the analysis. We excluded women who were pregnant at the time of the interview and women who answered 'Other' for religion due to the small sample size (n=8). ...
... Third, the analysis relies on the assumption that anaemia at interview is a proxy for anaemia at contraceptive initiation. Previous studies 22 have indeed shown that iron trajectories are fairly stable over time, and the current analysis shows that, if anything, haemoglobin levels increase slightly with injectable use. Therefore, it is reasonable to assume that anaemia levels were either similar or more severe at the time of injectable initiation. ...
Introduction
This paper investigates the importance of women’s physiological condition for predicting the risk of discontinuation due to side-effects of the injectable contraceptive in Ethiopia, where side-effects account for around 20% of all discontinuations.
Methods
Contraceptive calendar data from the 2016 Ethiopian Demographic and Health Survey were analysed. Women aged 15-49 who had initiated the injectable contraceptive in the two years prior to interview were included in the analysis (N=1,513). After checking for reverse causality, the associations between physiological risk factors and discontinuation of the injectable contraceptive due to either side-effects (DSE) or other reasons (DOR) were estimated using multivariate Cox proportional regression analyses.
Results
In 2016, 10% of women had initiated the injectable in the last two years, and 1 in 4 had discontinued use by the time of the interview. Of these, 1 in 5 discontinued due to side-effects. Women with anaemia were at twice the risk of DSE compared with non-anaemic women, while anaemia status was not associated with DOR. The association between anaemia and experience of side-effects is likely driven by iron-deficiency anaemia, as having taken iron supplements during last pregnancy is found to decrease the risk of DSE. Sociocultural factors including religion, wealth and relationship status were significant predictors for DOR, but not for DSE.
Conclusion
Accounting for diversity in physiological condition is key for understanding contraceptive discontinuation due to side-effects. To reduce side-effects and thereby unmet need for contraception, family planning programs may benefit from providing an integrated service package addressing anaemia as well as supplying hormonal contraception.
