Rupak Desai, Sandeep Singh, Krupa Patel, Hemant Goyal, Manan Shah, Zeeshan Mansuri, Smit Patel, Zabeen K Mahuwala, Larry B Goldstein and Adnan I Qureshi
BACKGROUND : Recent legalization of therapeutic and recreational cannabis use makes it imperative to have an insight into odds and trends in young-onset stroke-related hospitalizations among cannabis users (18-49 years).
METHODS : The National Inpatient Sample dataset (2007-2014) was utilized to assess national trends, odds of young-onset stroke-related hospitalizations, and outcomes among cannabis users vs. nonusers using provided discharge weights, strata, and cluster design. The rates are described per 100,000 hospitalizations among cannabis users and non-users.
RESULTS : A total of 3,307,310 hospitalizations were identified among young adults with current or previous cannabis use. Of these, 34,857 (1.1%) were related to young-onset stroke. A relative increase of 13.92% (553 in 2007 to 630 in 2014; ptrend < 0.001) in young-onset stroke admissions was reported among cannabis users. The odds of any stroke (OR 1.16, 95% CI 1.14-1.19, p < 0.001) and acute ischemic stroke (OR 1.41, 95% CI 1.31-1.51, p < 0.001) hospitalizations were considerably higher among cannabis users as compared to nonusers. In-hospital mortality rates were increasing (3.7% to 4.3%) among cannabis users whereas decreasing (7.7% to 5.9%) in nonusers from 2007 to 2014 (ptrend < 0.001). The mean length of stay and the hospitalization charges showed increasing trends in cannabis-related young-onset stroke admissions. There was an increasing trend in young-onset stroke admissions among male cannabis users (578 to 701; ptrend < 0.001) but not among females (516 to 457; ptrend = 0.14). The maximum rise in the young-onset stroke-related admissions was seen in African Americans (743 to 996; ptrend < 0.001).
CONCLUSIONS : We identified rising trends and higher risk (16% higher of overall young-onset stroke, 41% higher of acute ischemic stroke) of stroke-related hospitalizations and worse outcomes among cannabis users aged 18-49 years from 2007 to 2014.
KEYWORDS : Cannabis; acute ischemic stroke; legalization; marijuana; recreational use; trends; young-onset stroke
According to the Centers for Disease Control and Prevention (CDC), stroke in people younger than 65 years accounts for 34% of all hospitalizations. In adolescents and young adults (aged 15–44 years), the prevalence of acute ischemic stroke (AIS) hospitalizations increased during 1995–2008.1 Increased odds of hospitalizations for strokes among cannabis users in the United States has also been reported in previous literature.2 Marijuana’s principal active constituent, tetrahydrocannabinol (THC) is detrimental due to its direct dose-dependent effects on mitochondrial function and increased production of reactive oxygen species in the brain.3 The increasing popularity of cannabis use in younger adults due to recent favor toward cannabis legalization and decriminalization is highly concerning.2 Thus, this study aims to investigate the odds and temporal trends in young-onset stroke (YOS)-related admissions, subsequent in-hospital mortality, length of stay (LOS), hospitalization charges, and gender- and race based variations among cannabis users aged 18–49 years.