Chronic rhinosinusitis increases the risk of hemorrhagic and ischemic stroke: A longitudinal follow-up study using a national sample cohort

BACKGROUND Several studies have reported that chronic rhinosinusitis (CRS) increases the risk of stroke. The aim of this study is to elucidate the putative association between CRS and stroke (ischemic or hemorrhagic) using large population-based national health insurance data. METHODS Using the national cohort study from the Korean Health Insurance Review and Assessment Service, CRS patients (n = 22,959) and control participants (n = 91,836) were selected and matched at a rate of 1:4 (age, sex, income, region, hypertension, diabetes, and dyslipidemia). A Cox-proportional hazard model was used to analyze the hazard ratio (HR) of CRS for hemorrhagic stroke and ischemic stroke. We divided the participants according to age and gender for the subgroup analysis. RESULTS The HR for hemorrhagic and ischemic stroke was significantly increased in the CRS patients compared to that in the controls (adjusted HR = 2.43, 95% confidence interval [CI] = 2.10-2.80 for hemorrhagic stroke; adjusted HR = 1.76, 95% CI = 1.61-1.92 for ischemic stroke) after adjusting for age, sex, income, region of residence, hypertension, diabetes, dyslipidemia, ischemic heart disease, migraine, chronic kidney disease, depression, sleep disorder, and chronic obstructive pulmonary disorder. In the subgroup analysis, the HR of hemorrhagic stroke was significantly increased in the CRS group regardless of age and gender. The HR of ischemic stroke was also significantly increased in all subgroups of the CRS group. CONCLUSION CRS consistently increased the risk of ischemic and hemorrhagic stroke regardless of age and gender.