Abstract
Background : This study investigated the correlation between a history of subconjunctival hemorrhages (SCH) and risk of systemic autoimmune diseases. Methods: We conducted a nationwide cohort study by our national insurance database. The study cohort comprised 16641 patients with incident SCH diagnosed by ophthalmologists between 2000 and 2012 and 16641 propensity score matched non-SCH comparison cohort by demographic characteristics and comorbidities. All study individuals were followed up until they developed systemic autoimmune diseases such as autoimmune hemolytic anemia, rheumatoid arthritis, systemic lupus erythematosus, Sjogren’s syndrome, systemic sclerosis , or dermatomyositis, withdraw from the insurance program, were lost to follow-up, or until the end of 2013. Cox proportional hazards regression analysis was used to analyze the risk of autoimmune diseases with hazard ratios (HRs) and 95% confidence intervals (CIs) between the NTS and comparison cohort. We also implemented a negative outcome control (motor vehicle traffic accident) to detect residual confounding. Results: 2,345 of all 33,282 patients developed autoimmune diseases during a 247,995 follow up person-years. The adjusted HRs (95% CI) of autoimmune diseases for SCH patients relative to controls was 1.61 (1.48, 1.75) after adjusting sex, age comorbidities and. (p<0.0001). The subgroup analysis indicated that there was a significantly different risk of autoimmune diseases among age subgroups (p for interaction =0.0464) and chronic obstructive pulmonary disease (COPD). (p for interaction =0.0298). Conclusions: This nationwide cohort study of 16641 patients with subconjunctival hemorrhages (SCH) and 16641 matched non-SCH comparison cohort revealed SCH was associated with 1.61 fold risk of subsequent systemic autoimmune diseases . Age and chronic obstructive pulmonary disease acted as effect modifiers Funding Information: This work was supported by Taiwan Ministry of Health and Welfare Clinical Trial Center (MOHW108-TDU-B-212-133004), China Medical University Hospital, Academia Sinica Stroke Biosignature Project (BM10701010021). Declaration of Interests: All of the authors declared no competing interests. Ethics Approval Statement: The Research Ethics Committee of China Medical University and Hospital in Taiwan approved the study (CMUH104-REC2-115(AR-4)).
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