Abstract
Background: A significant proportion of cancer survivors (CS) use cannabis; there is emerging evidence of a link between cannabis use and increase in risk of ischemic stroke in the general population. This evidence presents concern for CS who use cannabis, as cancer is associated with an increased risk of stroke and worse post-stroke outcomes. This study investigated the use of cannabis in CS to determine if there is a relationship between cannabis use and stroke risk.
Methods: Cross-sectional data from 2007-2018 National Health and Nutrition Examination Survey were utilized among cancer survivors. Summary statistics for demographics were calculated for overall sample and by subgroup. Chi-square statistics and Student’s t-tests were calculated. Univariate and multivariable logistic regression models for having stroke were fit to determine if cannabis use is a risk factor. Crude odds ratio, adjusted odds ratios (aOR) and corresponding 95% confidence intervals (95%CI) were calculated.
Results: There were 789 CS with an average age of 47 ± 10 years. The majority reported cannabis use (60.3%). Stroke prevalence was 6.2% in the overall sample (6.7% in cannabis users and 5.4% in non-users; p=0.46). Cannabis use history differed by sex, race, education, BMI, cigarette smoking and household smoke exposure (all p-values <0.05). In univariate regression, odds of having stroke were 50.1% lower in males compared to females, and 78.9% lower in those with a college degree compared to a high school diploma or GED. Stroke risk increased with age (1.05; 1.01-1.09), widowed status compared to married (3.96; 1.09-14.25), and NH Black compared to NH White (2.15; 1.02-4.26). In multivariable models, race (NH Black compared to NH White (aOR:3.54; 95%CI 1.49-8.45), asthma (2.24; 1.57-6.68), and diabetes (3.38; 1.50-7.60) were significantly associated with increased risk of stroke.
Conclusion: Cannabis use was not associated with an increased or decreased risk of stroke among CS. The final model indicates that demographics and comorbidities are the strongest predictors of stroke among young CS.