Abstract
ObjectivesA previous population-based study reported an increased risk of stroke after the occurrence of adhesive capsulitis of the shoulder (ACS), but there were substantial imbalances in the distribution of age and pre-existing vascular risk factors between subjects with ACS and without ACS, which might lead to a confounded association between ACS and stroke. The purpose of the present large-scale propensity score-matched population-based follow-up study was to clarify whether there is an increased stroke risk after ACS.MethodsWe used a logistic regression model that includes age, sex, pre-existing comorbidities and socioeconomic status as covariates to compute the propensity score. A total of 22025 subjects with at least two ambulatory visits with the principal diagnosis of ACS in 2001 was enrolled in the ACS group. The non-ACS group consisted of 22025, propensity score-matched subjects without ACS. The stroke-free survival curves for these 2 groups were compared using the Kaplan-Meier method. Stratified Cox proportional hazard regression with patients matched on propensity score was used to estimate the effect of ACS on the occurrence of stroke.ResultsDuring the two-year follow-up period, 657 subjects in the ACS group (2.98%) and 687 in the non-ACS group (3.12%) developed stroke. The hazard ratio (HR) of stroke for the ACS group was 0.93 compared to the non-ACS group (95% confidence interval [CI], 0.83–1.04, P = 0.1778). There was no statistically significant difference in stroke subtype distribution between the two groups (P = 0.2114).ConclusionsThese findings indicate that ACS itself is not associated with an increased risk of subsequent stroke.
Highlights
Adhesive capsulitis of the shoulder (ACS) is characterized by intense shoulder pain with progressive limitation of shoulder mobility in all planes [1]
The ACS group was significantly older and had a 1.5-fold higher prevalence of diabetes and hyperlipidemia than the nonACS group. Such a significant imbalance may not be effectively overcome by adjustment for these potential confounding factors in multiple regression analysis, especially when the estimated increase in stroke risk associated with ACS is only modest
Diabetes, and hyperlipidemia are well-known risk factors for stroke [8,9,10,11], this raises the possibility that the modest association between ACS and stroke may be attributed to the imbalance in these risk factors, rather than ACS itself
Summary
Adhesive capsulitis of the shoulder (ACS) is characterized by intense shoulder pain with progressive limitation of shoulder mobility in all planes [1]. Compared to the non-ACS subjects, the estimated hazard ratio of stroke for the ACS patients was 1.22 after adjusting for demographic characteristics, diabetes, hypertension, and heart diseases [7]. The ACS group was significantly older and had a 1.5-fold higher prevalence of diabetes and hyperlipidemia than the nonACS group. Such a significant imbalance may not be effectively overcome by adjustment for these potential confounding factors in multiple regression analysis, especially when the estimated increase in stroke risk associated with ACS is only modest.
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