Trigger Factors Of Hemorrhagic Stroke:A Case-Crossover Study

Objective: Hemorrhagic stroke(HS)is an acute disease due to rupture of abnormal arteries or small arterial vessels in the brain parenchyma.Elderly,female,and hypertension are known chronic risk factors for HS.However,as an acute disease,it is not clear whether patients have certain trigger factors before the onset of the disease.The aim of this study was to explore the trigger factors of HS to improve the understanding of HS onset,and to provide a basis for better prevention of HS.Methods: A case-crossover design was used in this study.Patients with HS were interviewed by questionnaire between March 1,2021 and January 18,2022 at the Department of Neurosurgery and Neurology in Xiangya Hospital and Hunan Provincial People’s Hospital,Changsha,Hunan Province.General demographic characteristics,disease history,and 13 potential triggers(Valsalva maneuvers,postural changes,play mahjong or cards,physical activity,etc.)during the hazard and control periods and other information were collected.The data were analyzed by SPSS,general demographic data and exposure of trigger factors in hazard and control period were described,associations between each trigger factor and risk of HS onset were analyzed using conditional logistic regression,and finally population attributable risk(PAR)was calculated to assess the public health significance of each trigger factor.Results: A total of 284 patients with HS were investigated in this study,with a mean age of 54.11±15.62 years and 51.05% male.Multifactorial analysis revealed that compared with the day before HS onset,straining for defecation(OR=3.06,95% CI 1.01-8.40),lifting heavy objects(OR=4.82,95% CI 1.02-22.83),playing mahjong or cards(OR=2.51,95% CI 1.05-6.01),vigorous physical activity(OR=3.02,95% CI 1.18-7.78),and overeating(OR=4.33,95% CI 1.24-15.21)were associated with the risk of HS onset within 2 hours(all p values less than 0.05);the occurrence of a major life event 1 week prior to onset was significantly associated with the risk of HS compared to 1 month prior to HS onset(OR=3.81,95% CI 1.06-13.74).HS was associated with vigorous physical activity in 11.35% of the population,followed by lifting over 25 kg(10.80%),play mahjong or cards(7.38%),overeating(6.57%),straining for defecation(5.49%)and major life events(4.84%).Conclusion: Valsalva maneuvers(straining for defecation and lifting≥25 kg),playing mahjong or cards,vigorous physical activity,overeating,and major life events may be triggers for the onset of HS,prevention of these triggers may reduce the risk of HS.