Evidence on the association between chronic hepatitis B virus (HBV) infection and stroke is limited, inconsistent, and confined to endemic regions in Asia.We aimed to investigate the association between chronic HBV infection and overall stroke, as well as its major subtypes.Using the database of the largest healthcare provider in Israel, we identified all individuals aged 20 and over who were tested for HBsAg (hepatitis B surface antigen) between 2005 and 2023.Newly diagnosed HBV patients who tested positive for HBsAg were propensity score-matched to non-HBV subjects who tested negative for HBsAg in a 1:4 ratio.The cohort was followed for the occurrence of stroke through 2024.The study included 20,544 HBV patients and 82,176 non-HBV controls.Overall stroke was diagnosed in 472 patients in the HBV group and 1,717 in the non-HBV group, reflecting incidence rates of 2.13 and 1.94 per 1,000 person-years, respectively.The hazard ratios (HRs) were 1.09 (95% CI, 0.98-1.22)for overall stroke, 1.01 (95% CI, 0.89-1.14)for ischemic stroke, and 1.82 (95% CI, 1.35-2.45)for intracerebral hemorrhage (ICH).The risk of ischemic stroke was increased in younger individuals and females (p-for interaction = 0.006 and 0.079, respectively).Results remained consistent when excluding patients with prior stroke.Exploratory analysis suggested that coinfection with hepatitis D is associated with increased risk of ICH.In conclusion, HBV infection was associated with increased risk of ICH.Also, the risk for ischemic stroke was higher in specific subgroups, including females, younger patients, and those coinfected with hepatitis D.
Yahav et al. (Tue,) studied this question.