Chickenpox and risk of stroke: a self-controlled case series analysis. Thomas, S. L., Minassian, C., Ganesan, V., Langan, S. M., & Smeeth, L. Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America, 58(1):61--68, January, 2014.
doi  abstract   bibtex   
BACKGROUND: There is good evidence that respiratory and other infections that cause systemic inflammation can trigger strokes; however, the role of specific infections is unclear. Case reports have highlighted chickenpox as a possible risk factor for arterial ischemic stroke, particularly in children, but rigorous studies are needed to determine and quantify any increased risk. METHODS: We used anonymized electronic health records totaling \textgreater100 million person-years of observation from 4 UK primary care databases to identify individuals who had documented clinical chickenpox and a stroke or transient ischemic attack (TIA). Self-controlled case series methods were used to quantify any increased risk of first stroke or TIA in the 0-6 and 7-12 months following chickenpox compared to other observed time periods. We analyzed data within each database, and performed meta-analyses to obtain summary age-adjusted incidence ratios (IRs) separately for adults and children. RESULTS: Five hundred sixty eligible individuals (including 60 children) were identified who experienced chickenpox and a stroke or TIA during follow-up. Among children, there was a 4-fold increased risk of stroke in the 0-6 months after chickenpox (summary IR = 4.07; 95% confidence interval [CI], 1.96-8.45; I(2) = 0%). Among adults, there was a less marked increased risk with moderate between-database heterogeneity (random-effects summary IR = 2.13; 95% CI, 1.05-4.36; I(2) = 51%). There was no significant increased risk of stroke in the 7-12 months after chickenpox in children or adults, nor was there evidence of increased risk of TIA in either time period. CONCLUSIONS: Our study provides new evidence that children who experience chickenpox are at increased risk of stroke in the subsequent 6 months.
@article{thomas_chickenpox_2014,
	title = {Chickenpox and risk of stroke: a self-controlled case series analysis},
	volume = {58},
	issn = {1537-6591},
	shorttitle = {Chickenpox and risk of stroke},
	doi = {10.1093/cid/cit659},
	abstract = {BACKGROUND: There is good evidence that respiratory and other infections that cause systemic inflammation can trigger strokes; however, the role of specific infections is unclear. Case reports have highlighted chickenpox as a possible risk factor for arterial ischemic stroke, particularly in children, but rigorous studies are needed to determine and quantify any increased risk.
METHODS: We used anonymized electronic health records totaling {\textgreater}100 million person-years of observation from 4 UK primary care databases to identify individuals who had documented clinical chickenpox and a stroke or transient ischemic attack (TIA). Self-controlled case series methods were used to quantify any increased risk of first stroke or TIA in the 0-6 and 7-12 months following chickenpox compared to other observed time periods. We analyzed data within each database, and performed meta-analyses to obtain summary age-adjusted incidence ratios (IRs) separately for adults and children.
RESULTS: Five hundred sixty eligible individuals (including 60 children) were identified who experienced chickenpox and a stroke or TIA during follow-up. Among children, there was a 4-fold increased risk of stroke in the 0-6 months after chickenpox (summary IR = 4.07; 95\% confidence interval [CI], 1.96-8.45; I(2) = 0\%). Among adults, there was a less marked increased risk with moderate between-database heterogeneity (random-effects summary IR = 2.13; 95\% CI, 1.05-4.36; I(2) = 51\%). There was no significant increased risk of stroke in the 7-12 months after chickenpox in children or adults, nor was there evidence of increased risk of TIA in either time period.
CONCLUSIONS: Our study provides new evidence that children who experience chickenpox are at increased risk of stroke in the subsequent 6 months.},
	language = {eng},
	number = {1},
	journal = {Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America},
	author = {Thomas, Sara L. and Minassian, Caroline and Ganesan, Vijeya and Langan, Sinéad M. and Smeeth, Liam},
	month = jan,
	year = {2014},
	pmid = {24092802},
	pmcid = {PMC3864501},
	keywords = {Adult, Aged, Chickenpox, Child, Child, Preschool, Female, Great Britain, Humans, Infant, Male, Middle Aged, Risk Assessment, Risk Factors, Time Factors, incidence, stroke},
	pages = {61--68}
}

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