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Published on: August 30, 2020
Association of Recreational Marijuana Use with Aneurysmal Subarachnoid Hemorrhage
Kavelin Rumalla1, Adithi Y Reddy1, Manoj K Mittal2
1University of Missouri-Kansas City School of Medicine, Kansas City, Missouri.
Insights
Recreational marijuana use is independently linked to an 18% higher risk of aneurysmal subarachnoid hemorrhage (aSAH). This study highlights a potential association between cannabis and aSAH, warranting further investigation into underlying mechanisms.
Area of Science:
- Neurology
- Public Health
- Substance Use Research
Background:
- Aneurysmal subarachnoid hemorrhage (aSAH) is a critical neurological emergency.
- The impact of recreational cannabis use on aSAH risk remains incompletely understood.
- Previous research has not definitively established a causal link or quantified the risk associated with cannabis consumption.
Purpose of the Study:
- To investigate the association between cannabis use and hospitalizations for aneurysmal subarachnoid hemorrhage (aSAH).
- To determine if cannabis use is an independent predictor of aSAH.
- To analyze in-hospital outcomes for patients with aSAH who use cannabis.
Main Methods:
- Utilized the Nationwide Inpatient Sample (NIS) from 2004-2011.
- Identified patients aged 15-54 with a primary diagnosis of aSAH (ICD-9-CM 430).
- Employed bivariate and multivariate analyses to assess the effect of cannabis use on aSAH incidence and outcomes.
Main Results:
- Cannabis use was independently associated with an 18% increased likelihood of aSAH (OR: 1.18, 95% CI: 1.12-1.24).
- Cannabis use was more prevalent in younger, male, Black patients, and Medicaid enrollees with aSAH.
- No significant association was found between cannabis use and cerebral vasospasm, inpatient mortality, or adverse discharge.
Conclusions:
- Recreational marijuana use is an independent predictor of aSAH.
- Further research, including case-control studies, is needed to explore inpatient outcomes and mechanisms of cannabis-associated stroke.
Objective:
Our objective was to evaluate the effect of cannabis use on hospitalizations for aneurysmal subarachnoid hemorrhage (aSAH).
Methods:
The Nationwide Inpatient Sample (2004-2011) was used to identify all patients (age 15-54) with a primary diagnosis of aSAH (International Classification of Diseases, Ninth Edition, Clinical Modification 430). We identified patients testing positive for cannabis use using all available diagnosis fields. The incidence and characteristics of aSAH hospitalizations among cannabis users were examined. Bivariate and multivariate analyses were performed to determine the effect of cannabis use on aSAH and in-hospital outcomes.
Results:
Prior to adjustment, the incidence of aSAH in the cannabis cohort was slightly increased relative to the noncannabis cohort (relative risk: 1.07, 95% confidence interval [CI]: 1.02-1.11). Cannabis use in aSAH was more frequent among younger patients (40.44 ± 10.17 versus 43.74 ± 8.68, P < .0001), males (53.3% versus 40.76%, P < .0001), black patients (35.92% versus 19.10%, P < .0001), and Medicaid enrollees (31.13% versus 18.31%, P < .0001). The cannabis use cohort had greater overall illicit drug use but fewer medical risk factors for aSAH. Cannabis use (odds ratio: 1.18, 95% CI: 1.12-1.24) was found to be an independent predictor of aSAH when adjusting for demographics, substance use, and risk factors. Cannabis use was not associated with symptomatic cerebral vasospasm, inpatient mortality, or adverse discharge disposition.
Conclusions:
Our analysis suggests that recreational marijuana use is independently associated with an 18% increased likelihood of aSAH. Further case-control studies may analyze inpatient outcomes and other understudied mechanisms behind cannabis-associated stroke.
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