Abstract
Background:
The relationship between cannabis use and stroke prevalence remains incompletely characterized, with most studies limited by binary exposure classification. We examined the frequency-dependent association of cannabis use and stroke prevalence by subtype in a large, diverse national cohort.
Aims:
Our primary aim was to explore the relationship between cannabis use frequency and the adjusted prevalence of ischemic and hemorrhagic stroke.
Methods:
We conducted a cross-sectional analysis of 122,767 adults from the National Institutes of Health (NIH) All of Us Research Program who completed lifestyle surveys between 2017-2022. Cannabis use frequency was stratified into five categories: never, once or twice, monthly, weekly, and daily. Ischemic and hemorrhagic stroke diagnoses were identified using International Classification of Diseases (ICD) 9 and 10 codes. Multivariable logistic regression models were adjusted for age, sex, race/ethnicity, obesity, type 2 diabetes, alcohol, and tobacco use.
Results:
Among 122,767 participants, 2,765 (2.3%) had a history of stroke. After multivariable adjustment, a significant frequency-dependent association was found for ischemic stroke; compared to never-users, “once or twice” use was associated with a 10% increased odds (adjusted odds ratio (aOR) = 1.10, confidence interval (CI) = 0.95–1.26), monthly use with a 3% reduced odds (aOR = 0.97, CI = 0.73–1.29), weekly use with a 45% increased odds (aOR = 1.45, 95% CI = 1.19-1.77), and daily use with a 48% increased odds (aOR = 1.48, 95% CI = 1.26–1.74). In contrast, the odds of hemorrhagic stroke were elevated across all frequencies of cannabis use, with the highest odds observed in monthly users (aOR = 1.74, 95% CI = 1.21–2.51). These subtype-specific associations contributed to an overall increased odds of any stroke for weekly (aOR = 1.39) and daily (aOR = 1.44) users.
Conclusions:
In this large, nationally representative study, cannabis use was associated with stroke through two distinct, subtype-specific patterns. Odds of ischemic stroke demonstrated a clear dose-response relationship concentrated among frequent (weekly or daily) users, while odds of hemorrhagic stroke were elevated across all frequencies of use. These findings highlight the need to incorporate detailed cannabis use assessment into routine cerebrovascular risk stratification.
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Supplementary Material
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