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Background <p>Although traumatic brain injury (TBI) is a known risk factor for stroke, the modifying effects of alcohol consumption and smoking in older adults with TBI remain unclear. In this study, we aimed to investigate the risk of stroke after TBI and to assess whether alcohol consumption and smoking modify this association in adults aged ≥ 65 years.</p> Methods <p>We conducted a retrospective cohort study using the National Health Insurance Service (NHIS) database in South Korea. Adults aged ≥ 65 years with newly diagnosed TBI between 2010 and 2017 (<i>n</i> = 166,819) were compared with 1:1 age- and sex-matched controls without TBI (<i>n</i> = 166,817). Patients with a prior history of stroke or TBI, or those who developed stroke within 2 weeks of TBI diagnosis, were excluded. TBI was treated as a time-varying exposure. We applied time-dependent Cox regression models to estimate stroke risk, adjusting for age, sex, socioeconomic status, region, insurance type, and Charlson comorbidity index. Subgroup analyses were performed by TBI severity and stroke subtypes. Among the study population, 95,621 individuals had baseline health check-up data, allowing further adjustment for traditional stroke risk factors and stratified analyses by smoking and alcohol consumption.</p> Results <p>The incidence of stroke was 49.77 vs. 32.24 per 1,000 person-years in the TBI and control groups, respectively. TBI was associated with an elevated stroke risk (HR 1.52; 95% CI, 1.49–1.54), which remained significant after multivariable adjustment (HR 1.48; 95% CI, 1.43–1.53). Stroke risk was highest in patients with moderate-to-severe TBI, particularly for intracerebral hemorrhage (HR 8.42; 95% CI, 7.99–8.87). Stratified analyses revealed that heavy drinkers and current smokers had a higher post-TBI stroke risk than their respective counterparts.</p> Conclusions <p>In this large longitudinal study, TBI was significantly associated with an increased risk of subsequent stroke in the older population. Alcohol consumption and smoking were effect modifiers in the association between TBI and stroke. Our results suggest that modification of health-related behavior might be necessary in older adults to prevent stroke following TBI.</p>

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Stroke risk after traumatic brain injury in older adults : impact of smoking and alcohol consumption

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年4月17日

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  • Jihui Jeon,
  • Yoonjeong Choi,
  • Tae-Woo Kim,
  • Ja-Ho Leigh

摘要

Background

Although traumatic brain injury (TBI) is a known risk factor for stroke, the modifying effects of alcohol consumption and smoking in older adults with TBI remain unclear. In this study, we aimed to investigate the risk of stroke after TBI and to assess whether alcohol consumption and smoking modify this association in adults aged ≥ 65 years.

Methods

We conducted a retrospective cohort study using the National Health Insurance Service (NHIS) database in South Korea. Adults aged ≥ 65 years with newly diagnosed TBI between 2010 and 2017 (n = 166,819) were compared with 1:1 age- and sex-matched controls without TBI (n = 166,817). Patients with a prior history of stroke or TBI, or those who developed stroke within 2 weeks of TBI diagnosis, were excluded. TBI was treated as a time-varying exposure. We applied time-dependent Cox regression models to estimate stroke risk, adjusting for age, sex, socioeconomic status, region, insurance type, and Charlson comorbidity index. Subgroup analyses were performed by TBI severity and stroke subtypes. Among the study population, 95,621 individuals had baseline health check-up data, allowing further adjustment for traditional stroke risk factors and stratified analyses by smoking and alcohol consumption.

Results

The incidence of stroke was 49.77 vs. 32.24 per 1,000 person-years in the TBI and control groups, respectively. TBI was associated with an elevated stroke risk (HR 1.52; 95% CI, 1.49–1.54), which remained significant after multivariable adjustment (HR 1.48; 95% CI, 1.43–1.53). Stroke risk was highest in patients with moderate-to-severe TBI, particularly for intracerebral hemorrhage (HR 8.42; 95% CI, 7.99–8.87). Stratified analyses revealed that heavy drinkers and current smokers had a higher post-TBI stroke risk than their respective counterparts.

Conclusions

In this large longitudinal study, TBI was significantly associated with an increased risk of subsequent stroke in the older population. Alcohol consumption and smoking were effect modifiers in the association between TBI and stroke. Our results suggest that modification of health-related behavior might be necessary in older adults to prevent stroke following TBI.